Provider Demographics
NPI:1174624530
Name:PRADEEP S. GHIA, M.D., P.C.
Entity type:Organization
Organization Name:PRADEEP S. GHIA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:GHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-258-6211
Mailing Address - Street 1:123 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3808
Mailing Address - Country:US
Mailing Address - Phone:610-258-6211
Mailing Address - Fax:610-258-9995
Practice Address - Street 1:123 S 22ND ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3808
Practice Address - Country:US
Practice Address - Phone:610-258-6211
Practice Address - Fax:610-258-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-037787-L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116979OtherHIGHMARK BLUE SHIELD
NJ5272700Medicaid
PADQ9730OtherPALMETTA GBA MEDICARE RAILROAD
PA9497710003Medicaid
PA03201100OtherCAPITAL BLUE CROSS
NJDQ3372OtherPALMETTA GBA MEDICARE RAILROAD
NJDQ3372OtherPALMETTA GBA MEDICARE RAILROAD
PA03201100OtherCAPITAL BLUE CROSS
NJB37023Medicare UPIN
PA116979OtherHIGHMARK BLUE SHIELD