=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538021357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. TARUN SHETTY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 MICHIGAN AVENUE NW
-----------------------------------------------------
City | WASHINGTON DC
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-650-2861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 PATTERSON ST NE, WASHINGTON DC
-----------------------------------------------------
City | WASHINGTON DC
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | MTL600211607
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------