Provider Demographics
NPI:1417987462
Name:TUCHINDA, JALIT (MD)
Entity type:Individual
Prefix:DR
First Name:JALIT
Middle Name:
Last Name:TUCHINDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 PINE HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1661
Mailing Address - Country:US
Mailing Address - Phone:412-771-6003
Mailing Address - Fax:412-771-3575
Practice Address - Street 1:596 PINE HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1661
Practice Address - Country:US
Practice Address - Phone:412-771-6003
Practice Address - Fax:412-771-3575
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035022L174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007503970008Medicaid
204862OtherHEALTH AMERICA
1000109OtherGATEWAY
PAB40434Medicare UPIN
204862OtherHEALTH AMERICA
PA164231JXHMedicare PIN