Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD039618L | PA |
NPI | 1033104948 |
---|---|
Provider Name | Balu B Shetty |
First Address | Greensburg, PA 15601-5667 |
Second Address | N Huntingdon, PA 15642-2718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 27/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001171343001 | (05) | PA |
469329 | BS (01) | PA |
E23162 | (02) |