Provider Demographics
NPI:1407831266
Name:JAGGI, SAVITA P
Entity Type:Individual
Prefix:
First Name:SAVITA
Middle Name:P
Last Name:JAGGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 COTTMAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3728
Mailing Address - Country:US
Mailing Address - Phone:215-745-6566
Mailing Address - Fax:215-745-4028
Practice Address - Street 1:1337 COTTMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3728
Practice Address - Country:US
Practice Address - Phone:215-745-6566
Practice Address - Fax:215-745-4028
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003445L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU01417Medicare UPIN
PA520674Medicare PIN
PA5030120001Medicare NSC