MEDICARE: BALU B SHETTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD039618L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	469329	OTHER	PA	BS

General Provider Information

NPI Number	:	1033104948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALU B SHETTY MD

Provider Business Mailing Address
First Line	:	585 RUGH ST
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-5667
Country	:	US
Telephone Number	:	724-838-1534
Fax Number	:	724-838-1536

Provider Business Practice Location Address
First Line	:	8775 NORWIN AVE
Second Line	:	SUITE 113
City	:	N HUNTINGDON
State	:	PA
Zip	:	15642-2718
Country	:	US
Telephone Number	:	724-864-0503
Fax Number	:	724-864-0535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	10/27/2011

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Directions to “ BALU B SHETTY MD” Practice Location

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