Provider Demographics
NPI:1407836570
Name:SHETH, MUKUND V (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKUND
Middle Name:V
Last Name:SHETH
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 1:5335 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1022
Mailing Address - Country:US
Mailing Address - Phone:215-288-1200
Mailing Address - Fax:215-288-6607
Practice Address - Street 1:5335 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1022
Practice Address - Country:US
Practice Address - Phone:215-288-1200
Practice Address - Fax:215-288-6607
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021314E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55784Medicare UPIN
PA013740Medicare ID - Type Unspecified