Provider Demographics
NPI:1518003953
Name:PAREKH, PARAG DHIRAJLAL (MD)
Entity Type:Individual
Prefix:MR
First Name:PARAG
Middle Name:DHIRAJLAL
Last Name:PAREKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 TREASURE LK
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9053
Mailing Address - Country:US
Mailing Address - Phone:814-372-2389
Mailing Address - Fax:814-281-3154
Practice Address - Street 1:428 WINDMERE DR STE 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7644
Practice Address - Country:US
Practice Address - Phone:814-372-2389
Practice Address - Fax:814-281-3154
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443543207WX0009X, 207W00000X
MA234727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN061483000Medicaid
PA1007384840027Medicaid
PA1007384840027Medicaid
PA614146Medicare PIN
MA000542202Medicare PIN
PA459096ZR5QMedicare PIN
MN061483000Medicaid
MN180001289Medicare PIN