Provider Demographics
NPI:1164806840
Name:THATTE, AMIT
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:THATTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 TOFTREES AVE APT 330
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1951
Mailing Address - Country:US
Mailing Address - Phone:814-777-8778
Mailing Address - Fax:
Practice Address - Street 1:1850 EAST PARK AVE., SUITE 207
Practice Address - Street 2:PENN STATE HERSHEY MEDICAL GROUP
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-689-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209820390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program