Provider Demographics
NPI:1720053549
Name:SHETTY, ASHOK K (MD)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:K
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FOX PLAN RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2762
Mailing Address - Country:US
Mailing Address - Phone:412-373-2360
Mailing Address - Fax:412-373-2365
Practice Address - Street 1:118 FOX PLAN RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2762
Practice Address - Country:US
Practice Address - Phone:412-373-2360
Practice Address - Fax:412-373-2365
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037455L207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29897Medicare UPIN
PA099155PD9Medicare PIN