Provider Demographics
NPI:1578548343
Name:MOROVATI, SHAHROKH S (MD)
Entity Type:Individual
Prefix:
First Name:SHAHROKH
Middle Name:S
Last Name:MOROVATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 EAST MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7164
Mailing Address - Country:US
Mailing Address - Phone:302-737-4990
Mailing Address - Fax:302-737-5082
Practice Address - Street 1:324 EAST MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7164
Practice Address - Country:US
Practice Address - Phone:302-737-4990
Practice Address - Fax:302-737-5082
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1 OD00733208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000027301Medicaid
DE0000027301Medicaid
B66404Medicare UPIN