1164410585 NPI number — SUPRITHA A SHETTY M.D.

Table of content: SUPRITHA A SHETTY M.D. (NPI 1164410585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164410585 NPI number — SUPRITHA A SHETTY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHETTY
Provider First Name:
SUPRITHA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164410585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 TECHNOLOGY DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANONSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-9531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-531-2902
Provider Business Mailing Address Fax Number:
412-531-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3928 WASHINGTON RD STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC MURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-941-8877
Provider Business Practice Location Address Fax Number:
724-941-4745
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  20986 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD065791L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014314 . This is a "MEDICARE INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 185138 . This is a "HEALTH AMERICA INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 229426 . This is a "ADVANTRA GRP PROVIDER # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001545760 . This is a "HIGHMARK GRP PROVIDER # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 04400111000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 186004 . This is a "ADVANTRA INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P002253 . This is a "GATEWAY HP GRP PROVIDER # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1504772 . This is a "GATEWAY HP INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 229409 . This is a "HEALTH AMERICA GRP PROVIDER # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3378423 . This is a "AETNA GRP PROVIDER # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 110245304 . This is a "RAILROAD MC INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2147180 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017021060005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075827 . This is a "MEDICARE GROUP FOR PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 210966 . This is a "UPMC HP GRP # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1414361 . This is a "HIGHMARK INDIVIDUAL PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 207165 . This is a "UPMC HP INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 229409 . This is a "HEALTH ASSURANCE GRP # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DA9375 . This is a "RAILROAD MC GRP # PATEL MED ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1037778 . This is a "AETNA INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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