Provider Demographics
NPI:1215323936
Name:PATHAK, SANKET RAJENDRA
Entity type:Individual
Prefix:
First Name:SANKET
Middle Name:RAJENDRA
Last Name:PATHAK
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 1:1534 PARK AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1087
Mailing Address - Country:US
Mailing Address - Phone:484-526-7246
Mailing Address - Fax:866-291-6192
Practice Address - Street 1:1534 PARK AVE STE 310
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1087
Practice Address - Country:US
Practice Address - Phone:484-526-7246
Practice Address - Fax:866-291-6192
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD471264207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program