Provider Demographics
NPI:1508041641
Name:JAWAHAR SUVARNAKAR, MD INC.
Entity Type:Organization
Organization Name:JAWAHAR SUVARNAKAR, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWAHAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUVARNAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-371-7757
Mailing Address - Street 1:145 HOSPITAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1462
Mailing Address - Country:US
Mailing Address - Phone:814-371-7757
Mailing Address - Fax:814-375-0414
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-371-7757
Practice Address - Fax:814-375-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038239L207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110046276OtherTRAVELLERS RAILROAD MEDICARE
PA0007226140003Medicaid
PA0007226140001Medicaid
PA093563Medicare PIN
PA120016Medicare PIN
PAB35943Medicare UPIN