Provider Demographics
NPI:1275501793
Name:SHEVCHIK, GRANT J (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:J
Last Name:SHEVCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ALLEGHENY AVE
Mailing Address - Street 2:3 ALLEGHENY PLAZA SUITE 1
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-2072
Mailing Address - Country:US
Mailing Address - Phone:412-423-1048
Mailing Address - Fax:412-828-7580
Practice Address - Street 1:333 ALLEGHENY AVE
Practice Address - Street 2:3 ALLEGHENY PLAZA SUITE 1
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2072
Practice Address - Country:US
Practice Address - Phone:412-423-1048
Practice Address - Fax:412-828-7580
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD02249E207Q00000X
PAMD022494E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000799244Medicaid
PA103953Medicare PIN
PAB36535Medicare UPIN