Provider Demographics
NPI:1255512794
Name:GENERAL INTERNAL MEDICINE PRACTICE PC
Entity type:Organization
Organization Name:GENERAL INTERNAL MEDICINE PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEERAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-328-3503
Mailing Address - Street 1:461 SEAN LN
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1472
Mailing Address - Country:US
Mailing Address - Phone:610-328-3503
Mailing Address - Fax:
Practice Address - Street 1:1803 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1713
Practice Address - Country:US
Practice Address - Phone:610-328-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058113L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057108Medicare PIN