Healthcare Provider Details

I. General information

NPI: 1720007669
Provider Name (Legal Business Name): PANKAJ I. SHROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 WEST ST
MILFORD MA
01757-2236
US

IV. Provider business mailing address

176 WEST ST
MILFORD MA
01757-2236
US

V. Phone/Fax

Practice location:
  • Phone: 508-634-5050
  • Fax: 508-634-9621
Mailing address:
  • Phone: 508-634-5050
  • Fax: 508-634-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53433
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: