Provider Demographics
NPI:1740278779
Name:GREWAL, HARSH
Entity type:Individual
Prefix:
First Name:HARSH
Middle Name:
Last Name:GREWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-214-7967
Mailing Address - Fax:570-214-2800
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1011
Practice Address - Country:US
Practice Address - Phone:570-214-7967
Practice Address - Fax:570-214-2800
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4170112086S0120X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018618910001Medicaid
G80364Medicare UPIN
PA0018618910001Medicaid