Provider Demographics
NPI:1588631212
Name:HARJAI, KISHORE J (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:J
Last Name:HARJAI
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4093
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-6020
Practice Address - Fax:570-808-2306
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421879207RC0000X
IL036161255207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU039823OtherMEDICARE GROUP
PAP00040776OtherRR MEDICARE PIN
NY02412059Medicaid
PACC9269OtherRR MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA071021N8VMedicare ID - Type Unspecified
PAGU039823OtherMEDICARE GROUP