Provider Demographics
NPI:1053594408
Name:AFINIWALA, MITUL (MD)
Entity type:Individual
Prefix:
First Name:MITUL
Middle Name:
Last Name:AFINIWALA
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:PO BOX 825395
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5395
Mailing Address - Country:US
Mailing Address - Phone:717-339-3105
Mailing Address - Fax:717-339-3107
Practice Address - Street 1:455 S WASHINGTON ST
Practice Address - Street 2:SUITE 22
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2516
Practice Address - Country:US
Practice Address - Phone:717-339-3105
Practice Address - Fax:717-339-3107
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435655207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102264833Medicaid
PA143870FLTMedicare PIN