MEDICARE: INTERNAL MEDICINE ASSOCIATES OF NORTHWESTERN PA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD018905E	PA

General Provider Information

NPI Number	:	1487851192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF NORTHWESTERN PA PC

Provider Business Mailing Address
First Line	:	2931 PEACH STR
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16508-1842
Country	:	US
Telephone Number	:	814-456-6258
Fax Number	:	814-456-6258

Provider Business Practice Location Address
First Line	:	2931 PEACH STR
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16508-1842
Country	:	US
Telephone Number	:	814-456-6258
Fax Number	:	814-456-6258

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DILIP K. JANA
Credential	:	MD
Telephone Number	:	814-456-6258

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	06/07/2010

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