Healthcare Provider Details

I. General information

NPI: 1740253574
Provider Name (Legal Business Name): NIMESH K VESUWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 INNOVATION DR
YORK PA
17408-8815
US

IV. Provider business mailing address

82 TUNNEL RD
POTTSVILLE PA
17901-3869
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-8623
  • Fax: 717-862-5576
Mailing address:
  • Phone: 570-622-5455
  • Fax: 570-622-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD425267
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD425267
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: