Provider Demographics
NPI:1699153346
Name:JALOTA, DIVYA (DO)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:JALOTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 THISTLE HILL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-1161
Mailing Address - Country:US
Mailing Address - Phone:717-843-7348
Mailing Address - Fax:717-771-5393
Practice Address - Street 1:2030 THISTLE HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-1161
Practice Address - Country:US
Practice Address - Phone:717-843-7348
Practice Address - Fax:717-771-5393
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0197862084N0400X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program