Provider Demographics
NPI:1447228911
Name:GOVINDJI FULETRA MD PC
Entity Type:Organization
Organization Name:GOVINDJI FULETRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GOVINDJI
Authorized Official - Middle Name:B
Authorized Official - Last Name:FULETRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-258-6567
Mailing Address - Street 1:1950 HAY TERRACE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:610-258-6567
Mailing Address - Fax:610-258-6807
Practice Address - Street 1:1950 HAY TERRACE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-258-6567
Practice Address - Fax:610-258-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050804L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089695Medicare ID - Type Unspecified
PA089323Medicare ID - Type Unspecified
G00520Medicare UPIN