Provider Demographics
NPI:1255521290
Name:TRIVEDI, POORVI P (DO)
Entity type:Individual
Prefix:DR
First Name:POORVI
Middle Name:P
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:POORVI
Other - Middle Name:V
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3900 WOODLAND AVE
Mailing Address - Street 2:PHILADELPHIA VETERANS ADMINISTRATION MEDICAL CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4551
Mailing Address - Country:US
Mailing Address - Phone:215-823-5800
Mailing Address - Fax:215-823-4411
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:PHILADELPHIA VETERANS ADMINISTRATION MEDICAL CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:215-823-4411
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08295700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine