Provider Demographics
NPI:1720007669
Name:SHROFF, PANKAJ I (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:I
Last Name:SHROFF
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 1:176 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2236
Mailing Address - Country:US
Mailing Address - Phone:508-634-5050
Mailing Address - Fax:508-634-9621
Practice Address - Street 1:176 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2236
Practice Address - Country:US
Practice Address - Phone:508-634-5050
Practice Address - Fax:508-634-9621
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53433208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3078680Medicaid
MA3078680Medicaid
MAJ13584Medicare ID - Type Unspecified