Provider Demographics
NPI:1942274972
Name:SHETH, KETAN R (MD)
Entity Type:Individual
Prefix:
First Name:KETAN
Middle Name:R
Last Name:SHETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:100 N ACADEMY A VE SUITE 210
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2203
Practice Address - Country:US
Practice Address - Phone:717-724-6450
Practice Address - Fax:717-724-6451
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD049666L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014188610001Medicaid
PA0014188610001Medicaid
PAF57739Medicare UPIN