Provider Demographics
NPI:1841297975
Name:HATTI, SHIVKUMAR SHIVAPPA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:SHIVKUMAR
Middle Name:SHIVAPPA
Last Name:HATTI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHESLEY DR
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1760
Mailing Address - Country:US
Mailing Address - Phone:610-891-9024
Mailing Address - Fax:610-891-9699
Practice Address - Street 1:107 CHESLEY DR
Practice Address - Street 2:UNIT 4
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1760
Practice Address - Country:US
Practice Address - Phone:610-891-9024
Practice Address - Fax:610-891-9699
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037729L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA847252Medicaid
PA083401RNDMedicare ID - Type Unspecified
PA847252Medicaid