Provider Demographics
NPI:1649324955
Name:SHOLEVAR, GHODRAT P (MD)
Entity type:Individual
Prefix:DR
First Name:GHODRAT
Middle Name:P
Last Name:SHOLEVAR
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 1:222 RIGHTERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1315
Mailing Address - Country:US
Mailing Address - Phone:610-529-3136
Mailing Address - Fax:215-291-8069
Practice Address - Street 1:618 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133
Practice Address - Country:US
Practice Address - Phone:215-229-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032346-L2084P0804X, 2084P0800X
NJ25MA05805100207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011198830001OtherPROMISE NUMBER