Provider Demographics
NPI:1366555104
Name:RAI, JITHENDRA (MD)
Entity type:Individual
Prefix:
First Name:JITHENDRA
Middle Name:
Last Name:RAI
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 1:6133 VOLKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506
Mailing Address - Country:US
Mailing Address - Phone:814-454-4599
Mailing Address - Fax:814-454-4503
Practice Address - Street 1:2620 SIGSBEE STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-454-4599
Practice Address - Fax:814-454-4503
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070947L208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018351850002Medicaid
PARA423213OtherHIGHMARK SHIELD
PA040882QAUMedicare ID - Type Unspecified
PA0018351850002Medicaid