Healthcare Provider Details

I. General information

NPI: 1679774467
Provider Name (Legal Business Name): NEERAV G. SHETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDUSTRIAL BLVD STE 200
PAOLI PA
19301-1648
US

IV. Provider business mailing address

207 N BROAD ST FL 3
PHILADELPHIA PA
19107-1500
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-4260
  • Fax: 610-647-7430
Mailing address:
  • Phone: 610-647-2400
  • Fax: 610-647-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101258287
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD438917
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: