Provider Demographics
NPI:1750320461
Name:PUREWAL, MITESWAR (MD)
Entity Type:Individual
Prefix:
First Name:MITESWAR
Middle Name:
Last Name:PUREWAL
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:PO BOX 33465
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0612
Mailing Address - Country:US
Mailing Address - Phone:888-985-2727
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:700 E TOWNSHIP LINE RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:484-458-1000
Practice Address - Fax:484-458-1001
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09172000207LP2900X, 208VP0014X
PAMD427899208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10506600001Medicaid
NJ261372V6LMedicare PIN
PA097490Q7RMedicare PIN
I48581Medicare UPIN