Provider Demographics
NPI:1316181571
Name:SHRISHRIMAL, SHRIPAL (MD)
Entity Type:Individual
Prefix:
First Name:SHRIPAL
Middle Name:
Last Name:SHRISHRIMAL
Suffix:
Gender:M
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:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-282-4060
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:389 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1743
Practice Address - Country:US
Practice Address - Phone:724-282-2216
Practice Address - Fax:724-282-1861
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430109207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102398828Medicaid
PASH2135773OtherPA BLUE SHIELD
000000275877OtherUNISON HEALTH PLAN
PAP00794090OtherRAILROAD MEDICARE
PA158385SLVMedicare PIN