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General NPI Number Information
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NPI Number | 1780114041
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Entity Type | Individual
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Provider Name | PRIYA JOHAL MD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 230 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1121
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Country | US
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Telephone | 215-762-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 42 S 15TH ST UNIT 1502
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2208
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Country | US
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Telephone | 215-251-4682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MT213376
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License Number State | PA
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