Healthcare Provider Details

I. General information

NPI: 1164013140
Provider Name (Legal Business Name): KEYSTONE ALLERGY AND ASTHMA CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date: 08/18/2021
Reactivation Date: 07/31/2023

III. Provider practice location address

310 EXTON COMMONS
EXTON PA
19341
US

IV. Provider business mailing address

310 EXTON CMNS
EXTON PA
19341-2450
US

V. Phone/Fax

Practice location:
  • Phone: 610-890-9990
  • Fax: 610-890-9991
Mailing address:
  • Phone: 484-897-7143
  • Fax: 484-328-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUJAL P GHELANI
Title or Position: PHYSICIAN
Credential: DO
Phone: 484-897-7143