Healthcare Provider Details

I. General information

NPI: 1295999431
Provider Name (Legal Business Name): SHARVARI DALAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5272
  • Fax:
Mailing address:
  • Phone: 267-934-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD445728
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberG6775
License Number StateZZ
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD445728
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: