Healthcare Provider Details

I. General information

NPI: 1205047354
Provider Name (Legal Business Name): SHILPA JAIN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

200 LOTHROP ST FORBES TOWER, SUITE 9055
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5005
  • Fax:
Mailing address:
  • Phone: 412-647-3087
  • Fax: 412-647-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301086094
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD443563
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD443563
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: