Provider Demographics
NPI:1487211173
Name:ISRANI, AVANTIKA GUL (MBBS)
Entity Type:Individual
Prefix:
First Name:AVANTIKA
Middle Name:GUL
Last Name:ISRANI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 LANGHORNE-NEWTOWN ROAD, ST. MARY MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 LANGHORNE-NEWTOWN ROAD, ST. MARY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-03-28
Deactivation Date:2020-01-16
Deactivation Code:
Reactivation Date:2020-02-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program