Provider Demographics
NPI:1992931620
Name:GOYAL, SHAMI (MD)
Entity type:Individual
Prefix:
First Name:SHAMI
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAMI
Other - Middle Name:RAJARAM
Other - Last Name:JAGTAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2566 HAYMAKER RD
Mailing Address - Street 2:MONROEVILLE
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3517
Mailing Address - Country:US
Mailing Address - Phone:412-858-2763
Mailing Address - Fax:
Practice Address - Street 1:2566 HAYMAKER RD
Practice Address - Street 2:MONROEVILLE
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3517
Practice Address - Country:US
Practice Address - Phone:412-858-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES0000OtherMEDICARE UPIN FOR RESIDENCY PROGRAM