Provider Demographics
NPI:1144213745
Name:SHROFF, SANATKUMAR C (MD)
Entity Type:Individual
Prefix:
First Name:SANATKUMAR
Middle Name:C
Last Name:SHROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANAT
Other - Middle Name:C
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:405 LIBERTY ST.
Mailing Address - Street 2:P.O.BOX 646
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0646
Mailing Address - Country:US
Mailing Address - Phone:724-736-0443
Mailing Address - Fax:724-736-0454
Practice Address - Street 1:405 LIBERTY ST.
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-0646
Practice Address - Country:US
Practice Address - Phone:724-736-0443
Practice Address - Fax:724-736-0454
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-04-22
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
PAMD049150L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1432584Medicaid
PA132462V78Medicare PIN
PA1432584Medicaid