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General NPI Number Information
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NPI Number | 1851687362
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Entity Type | Individual
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Provider Name | JITESH UMARVADIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 912 RUSSELL DR
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City | LEBANON
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State | PA
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Zip | 17042-7485
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Country | US
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Telephone | 717-272-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 912 RUSSELL DR
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City | LEBANON
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State | PA
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Zip | 17042-7485
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Country | US
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Telephone | 717-272-7971
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 0101255944
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MD459798
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License Number State | PA
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