Provider Demographics
NPI:1184825598
Name:TELLI, JODI M (PA-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:TELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2768
Mailing Address - Country:US
Mailing Address - Phone:724-689-1335
Mailing Address - Fax:724-689-1337
Practice Address - Street 1:44 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2768
Practice Address - Country:US
Practice Address - Phone:724-689-1335
Practice Address - Fax:724-689-1337
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0527512086X0206X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1184825598Medicaid