Provider Demographics
NPI:1043366446
Name:AMIT H SHETH MD PC
Entity Type:Organization
Organization Name:AMIT H SHETH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-863-6373
Mailing Address - Street 1:PO BOX 1909
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619
Mailing Address - Country:US
Mailing Address - Phone:301-883-6373
Mailing Address - Fax:301-863-6313
Practice Address - Street 1:22878 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619
Practice Address - Country:US
Practice Address - Phone:301-883-6373
Practice Address - Fax:301-863-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E03403Medicare UPIN