Provider Demographics
NPI:1003501792
Name:RAYAROTH, SWETHA
Entity Type:Individual
Prefix:
First Name:SWETHA
Middle Name:
Last Name:RAYAROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SWETHA
Other - Middle Name:
Other - Last Name:R
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 N. ACADEMY AVE., GEISINGER MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822
Mailing Address - Country:US
Mailing Address - Phone:570-271-6787
Mailing Address - Fax:
Practice Address - Street 1:100 N. ACADEMY AVE., GEISINGER MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822
Practice Address - Country:US
Practice Address - Phone:570-271-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2024-01-30
Deactivation Date:2023-11-13
Deactivation Code:
Reactivation Date:2024-01-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT228326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program