Provider Demographics
NPI:1366629511
Name:SHEVTZIV, YURIY (MD)
Entity Type:Individual
Prefix:
First Name:YURIY
Middle Name:
Last Name:SHEVTZIV
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 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:3735 NAZARETH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:610-829-2200
Practice Address - Fax:610-829-2211
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50080023OtherCAPITOL BLUE CROSS AND KEYSTONE CENTRAL - FORKS
PA50082459OtherCAPITOL BLUE CROSS AND KEYSTONE CENTRAL - EASTON
PA3539947000OtherINDEP BLUE CROSS/KEYSTONE EAST
PA1021927070001Medicaid
PA2062100OtherHIGHMARK BLUE SHIELD
PA50080023OtherCAPITOL BLUE CROSS AND KEYSTONE CENTRAL - FORKS