Provider Demographics
NPI:1780307017
Name:PARIKH, POOJA UMESH (PA-C)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:UMESH
Last Name:PARIKH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1063
Mailing Address - Country:US
Mailing Address - Phone:215-368-1114
Mailing Address - Fax:
Practice Address - Street 1:2031 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1063
Practice Address - Country:US
Practice Address - Phone:215-368-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA064133OtherPA-MD LICENSE
PAOA006294OtherPHYSICIAN ASSISTANT DO LICENSE