=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306334834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARTIK RAI DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2018
-----------------------------------------------------
Last Update Date | 04/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 174 HARVEST LN
-----------------------------------------------------
City | POCONO SUMMIT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18346-7761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-526-1735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 OSTRUM ST
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18015-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-266-0484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OT018274
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | OS022350
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------