Healthcare Provider Details

I. General information

NPI: 1144213745
Provider Name (Legal Business Name): SANATKUMAR C SHROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SANAT C SHROFF M.D.

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date: 03/27/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

405 LIBERTY ST.
PERRYOPOLIS PA
15473-0646
US

IV. Provider business mailing address

405 LIBERTY ST. P.O.BOX 646
PERRYOPOLIS PA
15473-0646
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-0443
  • Fax: 724-736-0454
Mailing address:
  • Phone: 724-736-0443
  • Fax: 724-736-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD049150L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: