Healthcare Provider Details

I. General information

NPI: 1649882036
Provider Name (Legal Business Name): GAURAV RAJ SHRESTHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE STREET
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

555 N DUKE STREET
LANCASTER PA
17602-2250
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-5511
  • Fax: 717-544-7673
Mailing address:
  • Phone: 717-544-5511
  • Fax: 717-544-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD494673
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD494673
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: