Provider Demographics
NPI:1669803961
Name:PATHAK, CAMY (RT (R)(CT)(ARRT))
Entity type:Individual
Prefix:
First Name:CAMY
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:RT (R)(CT)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 AVON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3433
Mailing Address - Country:US
Mailing Address - Phone:215-673-1662
Mailing Address - Fax:
Practice Address - Street 1:829 AVON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3433
Practice Address - Country:US
Practice Address - Phone:215-673-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA482575247100000X, 2471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist