Organization
PULMONARY & CRITICAL CARE MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJEEV JETHMALANI M.D. (OWNER)
(724) 537-2210
Entity
Organization
Contact information
Practice address
911 LIGONIER ST, SUITE 204, LATROBE, PA 15650-1805
(724) 537-2210
(724) 537-2545
Mailing address
911 LIGONIER ST, SUITE 204, LATROBE, PA 15650-1805
(724) 537-2210
(724) 537-2545
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032867
BLUE SHIELD GROUP
PA
Enumeration date
06/09/2006
Last updated
08/22/2020
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