Provider Demographics
NPI:1376553768
Name:JOTINDER K. PATHEJA M.D.P.C.
Entity Type:Organization
Organization Name:JOTINDER K. PATHEJA M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOTINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATHEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-575-0041
Mailing Address - Street 1:2787 WALKER CT
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-9307
Mailing Address - Country:US
Mailing Address - Phone:724-575-0041
Mailing Address - Fax:724-327-8647
Practice Address - Street 1:2787 WALKER CT
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-9307
Practice Address - Country:US
Practice Address - Phone:724-575-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038641L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01145450Medicaid
PA01145450Medicaid
E55498Medicare UPIN