Provider Demographics
NPI:1134285943
Name:PITHWA, SAPNA JUGNU (DO)
Entity Type:Individual
Prefix:
First Name:SAPNA
Middle Name:JUGNU
Last Name:PITHWA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1775
Mailing Address - Country:US
Mailing Address - Phone:704-827-3575
Mailing Address - Fax:704-827-0840
Practice Address - Street 1:112 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1775
Practice Address - Country:US
Practice Address - Phone:704-827-3575
Practice Address - Fax:704-827-0840
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905948Medicaid
OH000000346211OtherBCBS
OH2505944Medicaid
NC5905948Medicaid
NC2403519Medicare ID - Type UnspecifiedBESSEMER CITY FAMILY
OHI15588Medicare UPIN