Provider Demographics
NPI:1497043319
Name:KUNWAR, SHRISTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRISTI
Middle Name:
Last Name:KUNWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-0300
Mailing Address - Country:US
Mailing Address - Phone:717-270-7780
Mailing Address - Fax:717-274-9746
Practice Address - Street 1:4TH AND WALNUT STREETS
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6123
Practice Address - Country:US
Practice Address - Phone:717-270-4876
Practice Address - Fax:717-270-3875
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60672223207R00000X
PAMD452206208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102950380 0001Medicaid
PA102950380 0001Medicaid