Provider Demographics
NPI:1295891745
Name:TILAK, SHRIPAD P (MD)
Entity type:Individual
Prefix:DR
First Name:SHRIPAD
Middle Name:P
Last Name:TILAK
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 1:7 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3058
Mailing Address - Country:US
Mailing Address - Phone:609-269-5211
Mailing Address - Fax:
Practice Address - Street 1:7 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3058
Practice Address - Country:US
Practice Address - Phone:609-269-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT 0187208282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA36116Medicare UPIN