Provider Demographics
NPI: | 1740431220 |
---|---|
Name: | BAISWAR, SHALANKI (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | SHALANKI |
Middle Name: | |
Last Name: | BAISWAR |
Suffix: | |
Gender: | F |
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: | 785 5TH AVE |
Mailing Address - Street 2: | SUITE 3 |
Mailing Address - City: | CHAMBERSBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17201-4232 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-263-9555 |
Mailing Address - Fax: | 717-217-4218 |
Practice Address - Street 1: | 112 N 7TH ST |
Practice Address - Street 2: | |
Practice Address - City: | CHAMBERSBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17201-1720 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-217-4300 |
Practice Address - Fax: | 717-217-4217 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-10-02 |
Last Update Date: | 2020-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD448854 | 207R00000X, 208M00000X, 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 102901223 | Medicaid |