Provider Demographics
NPI:1285928200
Name:JOSHI, KOMAL (MD)
Entity type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:JOSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KOMAL
Other - Middle Name:
Other - Last Name:MUKESHKUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2017 GRAMERCY PL APT F12
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-7055
Mailing Address - Country:US
Mailing Address - Phone:847-412-8788
Mailing Address - Fax:
Practice Address - Street 1:2017 GRAMERCY PL APT F12
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-7055
Practice Address - Country:US
Practice Address - Phone:847-412-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466919207WX0107X, 207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13903214OtherCAQH