Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD02249E | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD022494E | PA |
NPI | 1275501793 |
---|---|
Provider Name | Dr. Grant J Shevchik |
First Address | Oakmont, PA 15139-2072 |
Second Address | Oakmont, PA 15139-2072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 26/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000799244 | (05) | PA |
B36535 | (02) | PA |