Provider Demographics
NPI:1083669295
Name:JETHVA, PURVI JITENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:PURVI
Middle Name:JITENDRA
Last Name:JETHVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PURVI
Other - Middle Name:JITENDRA
Other - Last Name:KAPADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 PENN SQUARE EAST
Mailing Address - Street 2:9TH FLOOR NORTH TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-425-9200
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:1201 LANGHORNE NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-2000
Practice Address - Fax:215-710-5801
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA085630002080N0001X
PAMD4254452080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021986940015Medicaid