Provider Demographics
NPI:1669492278
Name:VEERA, JYOTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:
Last Name:VEERA
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 1:15, BOWCREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707
Mailing Address - Country:US
Mailing Address - Phone:570-403-0484
Mailing Address - Fax:
Practice Address - Street 1:3110 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3630
Practice Address - Country:US
Practice Address - Phone:610-776-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-074251L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD-074251LOtherSTATE BOARD NUMBER