Provider Demographics
NPI:1578512612
Name:PATHEJA, HARPREET NINI (MD)
Entity Type:Individual
Prefix:DR
First Name:HARPREET
Middle Name:NINI
Last Name:PATHEJA
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 1:110 PEPPER HILL WAY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-642-6060
Mailing Address - Fax:803-642-0754
Practice Address - Street 1:110 PEPPER HILL WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-642-6060
Practice Address - Fax:803-642-0754
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT61803Medicaid
SCT61803Medicaid
F72296Medicare UPIN