Provider Demographics
NPI:1992753404
Name:TRIVEDI, ATUL D (MD)
Entity type:Individual
Prefix:
First Name:ATUL
Middle Name:D
Last Name:TRIVEDI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREEN LN STE 3
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5609
Mailing Address - Country:US
Mailing Address - Phone:215-788-2011
Mailing Address - Fax:215-781-1975
Practice Address - Street 1:100 GREEN LN STE 3
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-5609
Practice Address - Country:US
Practice Address - Phone:215-788-2011
Practice Address - Fax:215-781-1975
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039321L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009894540025Medicaid
PA30120528OtherKEYSTONE FIRST
PA4077171OtherAETNA
PAP01123867OtherRAILROAD MEDICARE
PA0009894540021Medicaid
PA452802OtherHIGHMARK BLUE SHIELD
PAP01123867OtherRAILROAD MEDICARE
PA452802R52Medicare PIN