Provider Demographics
NPI:1891997532
Name:SHORTT, CONOR PATRICK (MB, BCH, MSC, FRCR)
Entity Type:Individual
Prefix:DR
First Name:CONOR
Middle Name:PATRICK
Last Name:SHORTT
Suffix:
Gender:M
Credentials:MB, BCH, MSC, FRCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CHESTNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 S 10TH ST
Practice Address - Street 2:THOMAS JEFFERSON UNIVERSITY HOSPITAL, ROOM 1091
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5244
Practice Address - Country:US
Practice Address - Phone:215-955-5445
Practice Address - Fax:215-923-1562
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1897942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0201995Medicaid
PA1023226140001Medicaid
PA160064PAGMedicare PIN