Provider Demographics
NPI:1760472591
Name:PUNJANI, PERVEEN AB (MD)
Entity Type:Individual
Prefix:DR
First Name:PERVEEN
Middle Name:AB
Last Name:PUNJANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:323 MCKEAN AVE
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-1416
Mailing Address - Country:US
Mailing Address - Phone:724-489-9004
Mailing Address - Fax:724-489-0995
Practice Address - Street 1:323 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1416
Practice Address - Country:US
Practice Address - Phone:724-489-9004
Practice Address - Fax:724-489-0995
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425343208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013973700002Medicaid