Provider Demographics
NPI:1104567130
Name:GADHIYA, DHRUVKUMAR HARESHKUMAR
Entity type:Individual
Prefix:
First Name:DHRUVKUMAR
Middle Name:HARESHKUMAR
Last Name:GADHIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1431
Mailing Address - Country:US
Mailing Address - Phone:484-503-3073
Mailing Address - Fax:
Practice Address - Street 1:4311 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1431
Practice Address - Country:US
Practice Address - Phone:484-503-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125079263207ZP0102X
PAMT228366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology