Individual
JAMSHID KHADEMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 MULBERRY ST., SCRANTON, PA 18510-6800
(570) 703-8259
(570) 703-7250
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD064062L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01716353
—
PA
01
—
050083939
RR MEDICARE
PA
Enumeration date
11/08/2005
Last updated
08/10/2020
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