Provider Demographics
NPI:1932343217
Name:KURD, SHANU KOHLI (MD)
Entity Type:Individual
Prefix:
First Name:SHANU
Middle Name:KOHLI
Last Name:KURD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S BRYN MAWR AVE STE H321
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-4097
Mailing Address - Fax:484-337-4082
Practice Address - Street 1:130 S BRYN MAWR AVE STE H321
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-4097
Practice Address - Fax:484-337-4082
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453826207R00000X, 208M00000X
NC2013-01498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1859Medicaid
NC1932343217Medicaid
SCNC1859Medicaid