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General NPI Number Information
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NPI Number | 1376066282
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Entity Type | Individual
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Provider Name | SHIVRAJ GOYAL MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 288 SIZERVILLE RD
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City | EMPORIUM
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State | PA
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Zip | 15834-3944
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Country | US
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Telephone | 814-486-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 E 2ND ST
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City | COUDERSPORT
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State | PA
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Zip | 16915-8161
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Country | US
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Telephone | 814-274-9300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD472078
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License Number State | PA
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