Healthcare Provider Details

I. General information

NPI: 1114210994
Provider Name (Legal Business Name): JASLEEN KAUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JEFFERSON AVE HOSPITALIST
SCRANTON PA
18510-1639
US

IV. Provider business mailing address

746 JEFFERSON AVE HOSPITALIST
SCRANTON PA
18510-1639
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-5079
  • Fax: 570-340-5896
Mailing address:
  • Phone: 570-340-5079
  • Fax: 570-340-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD453103
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD453103
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA LIC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: