Provider Demographics
NPI:1699096347
Name:SHIVASHANKAR, RAINA (MD)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:SHIVASHANKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S 10TH ST
Mailing Address - Street 2:480 MAIN BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5244
Mailing Address - Country:US
Mailing Address - Phone:215-955-8900
Mailing Address - Fax:215-923-3447
Practice Address - Street 1:1101 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3612
Practice Address - Country:US
Practice Address - Phone:215-955-8900
Practice Address - Fax:215-923-3447
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54258207R00000X, 207RG0100X
PAMD456659207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01105546OtherMEDICARE RAILROAD
MN110014809Medicare PIN