Provider Demographics
NPI:1427025667
Name:DR. NOTARO-DR. SHETTY AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DR. NOTARO-DR. SHETTY AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-375-5401
Mailing Address - Street 1:2349 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2219
Mailing Address - Country:US
Mailing Address - Phone:724-375-5401
Mailing Address - Fax:724-375-6332
Practice Address - Street 1:2349 MILL ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2219
Practice Address - Country:US
Practice Address - Phone:724-375-5401
Practice Address - Fax:724-375-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018552950002Medicaid
PA047554Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #