Provider Demographics
NPI:1104811819
Name:TWAL, SHAFIC Y (MD)
Entity type:Individual
Prefix:
First Name:SHAFIC
Middle Name:Y
Last Name:TWAL
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 1:15 S 8TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2776
Mailing Address - Country:US
Mailing Address - Phone:724-463-0476
Mailing Address - Fax:724-463-1196
Practice Address - Street 1:15 S 8TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2776
Practice Address - Country:US
Practice Address - Phone:724-463-0476
Practice Address - Fax:724-463-1196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020149E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA848902OtherHIGHMARK
PA0006115170001Medicaid
PA0006115170001Medicaid