Provider Demographics
NPI:1235112293
Name:PENDURTHI, TRIBHUVAN KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:TRIBHUVAN
Middle Name:KUMAR
Last Name:PENDURTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8923
Mailing Address - Country:US
Mailing Address - Phone:610-882-0199
Mailing Address - Fax:610-882-2814
Practice Address - Street 1:3600 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8923
Practice Address - Country:US
Practice Address - Phone:610-882-0199
Practice Address - Fax:610-882-2814
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055454L208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG14783Medicare UPIN
PA796943LW3Medicare PIN