Provider Demographics
NPI:1972783819
Name:EXTON PRIMARY CARE P.C
Entity Type:Organization
Organization Name:EXTON PRIMARY CARE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARINEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANGADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-368-6395
Mailing Address - Street 1:115 JOHN ROBERT THOMAS DR
Mailing Address - Street 2:EXTON PRIMARY CARE P.C
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2653
Mailing Address - Country:US
Mailing Address - Phone:610-363-6433
Mailing Address - Fax:610-363-6883
Practice Address - Street 1:115 JOHN ROBERT THOMAS DR
Practice Address - Street 2:EXTON PRIMARY CARE P.C
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2653
Practice Address - Country:US
Practice Address - Phone:610-363-6433
Practice Address - Fax:610-363-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019187600001Medicaid