Provider Demographics
NPI:1740284009
Name:PATEL, SUSANJ SHANTU (MD)
Entity type:Individual
Prefix:
First Name:SUSANJ
Middle Name:SHANTU
Last Name:PATEL
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 1:401 LIBERTY AVE STE 2000
Mailing Address - Street 2:THREE GATEWAY CENTER, 20TH FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1029
Mailing Address - Country:US
Mailing Address - Phone:412-223-2272
Mailing Address - Fax:412-281-6320
Practice Address - Street 1:401 LIBERTY AVE STE 2000
Practice Address - Street 2:THREE GATEWAY CENTER, 20TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1029
Practice Address - Country:US
Practice Address - Phone:412-223-2272
Practice Address - Fax:412-281-6320
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD692272085R0202X
PAMD071371L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018270670007Medicaid
PA123342OtherHIGHMARK BCBS
PAP00706040OtherRAILROAD MEDICARE
PA123342OtherHIGHMARK BCBS
PA0018270670007Medicaid