Provider Demographics
NPI:1245495605
Name:SHATTAHI, ELIAS (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:SHATTAHI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-359-3360
Mailing Address - Fax:412-359-6899
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-3360
Practice Address - Fax:412-359-6899
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24045207RI0200X
PAMD448805207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028649070001Medicaid
WV3810017736Medicaid
WV3810017736Medicaid
PA1028649070001Medicaid