Healthcare Provider Details

I. General information

NPI: 1265040349
Provider Name (Legal Business Name): KRISHNA PARIKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DR STE 290
ROSTRAVER TWP PA
15012-4019
US

IV. Provider business mailing address

100 HOSPITAL AVE ATTN PROVIDER ENROLLMENT
DUBOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-6850
  • Fax: 678-553-0330
Mailing address:
  • Phone: 724-986-0698
  • Fax: 814-372-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD482233
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: