Provider Demographics
NPI:1013609957
Name:PEETHALA, MOUNIKA MUKHERJEE
Entity type:Individual
Prefix:
First Name:MOUNIKA MUKHERJEE
Middle Name:
Last Name:PEETHALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1927
Mailing Address - Country:US
Mailing Address - Phone:570-645-1950
Mailing Address - Fax:833-679-4141
Practice Address - Street 1:34 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1927
Practice Address - Country:US
Practice Address - Phone:570-645-1950
Practice Address - Fax:833-679-4141
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT228501207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine