Provider Demographics
NPI:1609624626
Name:BATHULA, KAVYA
Entity type:Individual
Prefix:
First Name:KAVYA
Middle Name:
Last Name:BATHULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEISINGER MIFFLINTOWN CLINIC
Mailing Address - Street 2:27 CJEMS LANE, SUITE 4, PO BOX 67
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059
Mailing Address - Country:US
Mailing Address - Phone:717-436-0129
Mailing Address - Fax:717-436-0130
Practice Address - Street 1:GEISINGER MIFFLINTOWN CLINIC
Practice Address - Street 2:27 CJEMS LANE, SUITE 4
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059
Practice Address - Country:US
Practice Address - Phone:717-436-0129
Practice Address - Fax:717-436-0130
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program