Provider Demographics
NPI:1053397489
Name:JHAVERI, MONA M (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:M
Last Name:JHAVERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1628
Mailing Address - Country:US
Mailing Address - Phone:717-426-1131
Mailing Address - Fax:717-426-2068
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-426-2068
Is Sole Proprietor?:No
Enumeration Date:2005-12-18
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073409L207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018600520002Medicaid
PA79573 S1QKOtherGEISINGER HEALTH PLAN
PA02267701OtherCAPITAL BLUE CROSS
PA1086330OtherAETNA HMO
PAH08610OtherHEALTH ASSURANCE
PA7621692OtherAETNA NON-HMO
PAP002954OtherGATEWAY HEALTH PLAN
PA1325027OtherHIGHMARK BLUE SHIELD
PA1086330OtherAETNA HMO
PAP002954OtherGATEWAY HEALTH PLAN