Basic Information
Provider Information
NPI: 1982228482
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATHAK
FirstName: RAJAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: UPMC PINNACLE INTERNAL MEDICINE PROGRAM
Address2: 205 S FRONT ST, SUITE 3C
City: HARRISBURG
State: PA
PostalCode: 17104
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: UPMC PINNACLE HOSPITALS
Address2: 205 S FRONT ST, SUITE 3C
City: HARRISBURG
State: PA
PostalCode: 17104
CountryCode: US
TelephoneNumber: 7172318506
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/01/2020
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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