Provider Demographics
NPI:1215386891
Name:TRIPATHI, PRAMOD K (MD)
Entity Type:Individual
Prefix:
First Name:PRAMOD
Middle Name:K
Last Name:TRIPATHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2005 TECHNOLOGY PKWY STE 440
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9413
Mailing Address - Country:US
Mailing Address - Phone:717-791-2540
Mailing Address - Fax:717-791-2549
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 440
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-791-2540
Practice Address - Fax:717-791-2549
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD474568207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103283539Medicaid
PA1Q7958OtherMEDICARE