Provider Demographics
NPI:1598287401
Name:THATTE, ANUJA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANUJA
Middle Name:
Last Name:THATTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OGLETOWN STANTON RD STE 4200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2075
Mailing Address - Country:US
Mailing Address - Phone:302-737-7700
Mailing Address - Fax:302-737-5407
Practice Address - Street 1:4701 OGLETOWN STANTON RD STE 4200
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2075
Practice Address - Country:US
Practice Address - Phone:302-737-7700
Practice Address - Fax:302-737-5407
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPROCESSING363A00000X
DEC5-0011608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000000Medicaid