Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD454786 | PA |
Y | 207VE0102X | Reproductive Endocrinologist | MD454786 | PA |
NPI | 1366568560 |
---|---|
Provider Name | Divya Kelath Shah |
First Address | Philadelphia, PA 19107-6130 |
Second Address | Philadelphia, PA 19107-6130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 18/10/2019 |