Provider Demographics
NPI:1992896237
Name:JARVIE, PATRICK A (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:JARVIE
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:GEISINGER PEDIATRICS
Mailing Address - Street 2:132 ABIGAIL LANE
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870
Mailing Address - Country:US
Mailing Address - Phone:814-272-7100
Mailing Address - Fax:814-272-6510
Practice Address - Street 1:GEISINGER PEDIATRICS
Practice Address - Street 2:132 ABIGAIL LANE
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870
Practice Address - Country:US
Practice Address - Phone:814-272-7100
Practice Address - Fax:814-272-6510
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003850208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6706908Medicaid
PA101045770Medicaid
NJ6398405Medicaid
MD2115010Medicaid
F95624Medicare UPIN
001115T34Medicare PIN