Provider Demographics
NPI:1346627122
Name:JEURKAR, CHETAN SHRIRANG (DO)
Entity Type:Individual
Prefix:
First Name:CHETAN
Middle Name:SHRIRANG
Last Name:JEURKAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 11TH ST FL 14
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-9937
Mailing Address - Fax:215-955-9791
Practice Address - Street 1:111 S 11TH ST FL 14
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-9937
Practice Address - Fax:215-955-9791
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018875207R00000X
PAOT016467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine