Provider Demographics
NPI:1356340566
Name:SHROFF, NIPANK N (MD PA)
Entity type:Individual
Prefix:
First Name:NIPANK
Middle Name:N
Last Name:SHROFF
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4937 RUSTIC TRAIL
Mailing Address - Street 2:MIDLAND UROLOGY CTR
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707
Mailing Address - Country:US
Mailing Address - Phone:432-699-2526
Mailing Address - Fax:432-699-1141
Practice Address - Street 1:4937 RUSTIC TRL
Practice Address - Street 2:MIDLAND UROLOGY CTR
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-1419
Practice Address - Country:US
Practice Address - Phone:432-699-2526
Practice Address - Fax:432-699-1141
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9992208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA1S034887201Medicaid
C21787Medicare UPIN
TX00MK43Medicare ID - Type Unspecified