Provider Demographics
NPI:1851687362
Name:UMARVADIA, JITESH (MD)
Entity Type:Individual
Prefix:
First Name:JITESH
Middle Name:
Last Name:UMARVADIA
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 1:912 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7485
Mailing Address - Country:US
Mailing Address - Phone:717-272-7971
Mailing Address - Fax:
Practice Address - Street 1:912 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7485
Practice Address - Country:US
Practice Address - Phone:717-272-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255944207QS0010X
PAMD459798207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA562563FLTMedicare PIN