1609624626 NPI number — KAVYA BATHULA

Table of content: KAVYA BATHULA (NPI 1609624626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609624626 NPI number — KAVYA BATHULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATHULA
Provider First Name:
KAVYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609624626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GEISINGER MIFFLINTOWN CLINIC
Provider Second Line Business Mailing Address:
27 CJEMS LANE, SUITE 4, PO BOX 67
Provider Business Mailing Address City Name:
MIFFLINTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-436-0129
Provider Business Mailing Address Fax Number:
717-436-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GEISINGER MIFFLINTOWN CLINIC
Provider Second Line Business Practice Location Address:
27 CJEMS LANE, SUITE 4
Provider Business Practice Location Address City Name:
MIFFLINTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-436-0129
Provider Business Practice Location Address Fax Number:
717-436-0130
Provider Enumeration Date:
05/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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