MEDICARE: DR. SHANTANU BISHWAL 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	207RR0500X	Rheumatology Physician	MD436784	PA

General Provider Information

NPI Number	:	1942400759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTANU BISHWAL MD

Provider Business Mailing Address
First Line	:	3440 LEHIGH ST STE 102
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-7001
Country	:	US
Telephone Number	:	484-658-5758
Fax Number	:	484-526-4091

Provider Business Practice Location Address
First Line	:	3440 LEHIGH ST STE 102
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-7001
Country	:	US
Telephone Number	:	484-658-5758
Fax Number	:	484-526-4091

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	05/07/2026

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