Organization
MAHENDRA M PUJARA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARRET PAULY (FRONT OFFICE)
(570) 622-1553
Entity
Organization
Contact information
Practice address
1630 MOUNT HOPE AVE, POTTSVILLE, PA 17901-1337
(570) 622-1553
(570) 622-3531
Mailing address
1630 MOUNT HOPE AVE, POTTSVILLE, PA 17901-1337
(570) 622-1553
(570) 622-3531
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD03778OL
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008314950001
—
PA
Enumeration date
11/09/2016
Last updated
11/09/2016
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