Provider Demographics
NPI:1598104176
Name:PATHAK, SWETHA NARAHARI (MD)
Entity Type:Individual
Prefix:DR
First Name:SWETHA
Middle Name:NARAHARI
Last Name:PATHAK
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 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:904-512-1899
Mailing Address - Fax:
Practice Address - Street 1:616 STATE ROAD 13 STE 8
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3868
Practice Address - Country:US
Practice Address - Phone:904-512-1899
Practice Address - Fax:904-770-7592
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01441207N00000X
PAMT203682390200000X
FLME155699207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program