Provider Demographics
NPI:1104812502
Name:JAIN, PRAVEER (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEER
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:206 E. BROWN ST.
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:500 PLAZA COURT, SUITE A
Practice Address - Street 2:PMC PHYSICIAN ASSOCIATES CARDIOLOGY
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-424-9970
Practice Address - Fax:570-424-2899
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-10-09
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Provider Licenses
StateLicense IDTaxonomies
PAMD057391L207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015877010009Medicaid
G27907Medicare UPIN
PA0015877010009Medicaid