Basic Information
| Provider Information | |||||||||
| NPI: | 1578757688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHATT | ||||||||
| FirstName: | RAVINDER | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 S FRONT ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318349 | ||||||||
| FaxNumber: | 7172318956 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 S FRONT ST | ||||||||
| Address2: | BMAB 3 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318508 | ||||||||
| FaxNumber: | 7172318535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 01/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD438029 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD438029 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102377416 | 05 | PA | MEDICAID | MD438029 | 01 | PA | PA STATE LICENSE | OTHER | P00896312 | 01 | PA | RAILROAD MEDICARE | OTHER |