Provider Demographics
NPI:1164410585
Name:SHETTY, SUPRITHA A (MD)
Entity Type:Individual
Prefix:
First Name:SUPRITHA
Middle Name:A
Last Name:SHETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:3928 WASHINGTON RD STE 220
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2594
Practice Address - Country:US
Practice Address - Phone:724-941-8877
Practice Address - Fax:724-941-4745
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20986207R00000X
PAMD065791L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014314OtherMEDICARE INDIVIDUAL
PA185138OtherHEALTH AMERICA INDIVIDUAL
PA229426OtherADVANTRA GRP PROVIDER # PATEL MED ASSOC
PA001545760OtherHIGHMARK GRP PROVIDER # PATEL MED ASSOC
WV04400111000Medicaid
PA186004OtherADVANTRA INDIVIDUAL
PAP002253OtherGATEWAY HP GRP PROVIDER # PATEL MED ASSOC
PA1504772OtherGATEWAY HP INDIVIDUAL
PA229409OtherHEALTH AMERICA GRP PROVIDER # PATEL MED ASSOC
PA3378423OtherAETNA GRP PROVIDER # PATEL MED ASSOC
PA110245304OtherRAILROAD MC INDIVIDUAL
OH2147180Medicaid
PA0017021060005Medicaid
PA075827OtherMEDICARE GROUP FOR PATEL MED ASSOC
PA210966OtherUPMC HP GRP # PATEL MED ASSOC
PA1414361OtherHIGHMARK INDIVIDUAL PROVIDER NUMBER
PA207165OtherUPMC HP INDIVIDUAL
PA229409OtherHEALTH ASSURANCE GRP # PATEL MED ASSOC
PADA9375OtherRAILROAD MC GRP # PATEL MED ASSOC
PA1037778OtherAETNA INDIVIDUAL
PADA9375OtherRAILROAD MC GRP # PATEL MED ASSOC
PA1037778OtherAETNA INDIVIDUAL