Provider Demographics
NPI:1891758504
Name:JAGDISH, KAMINI KRISHNASWAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMINI
Middle Name:KRISHNASWAMY
Last Name:JAGDISH
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8698
Mailing Address - Fax:
Practice Address - Street 1:250 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3363
Practice Address - Country:US
Practice Address - Phone:717-231-8772
Practice Address - Fax:717-231-8435
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215334207R00000X
PAMD449474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00391113OtherMEDICARE RAILROAD
NYWORKER'S COMPENSATIOOther215334-W CIM
NY02283329Medicaid
NYCC9323Medicare ID - Type Unspecified70008A GROUP
NY02283329Medicaid
NYHO8964Medicare UPIN
NYWORKER'S COMPENSATIOOther215334-W CIM