Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD418146 | PA |
N | 2080P0207X | Pediatric Hematology-Oncologist | MD418146 | PA |
NPI | 1104832377 |
---|---|
Provider Name | Suresh G Shelat |
First Address | Philadelphia, PA 19103-1443 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006971 | (05) | NJ |
I00681 | (02) |