Provider Demographics
NPI:1770579369
Name:SHETH, NIRAV (MD)
Entity type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:
Last Name:SHETH
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 1:575 BEECH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2223
Mailing Address - Country:US
Mailing Address - Phone:413-534-2870
Mailing Address - Fax:413-534-2869
Practice Address - Street 1:575 BEECH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2223
Practice Address - Country:US
Practice Address - Phone:413-534-2870
Practice Address - Fax:413-534-2869
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039946207RC0000X
MA226804207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001399460Medicaid
CT060001506Medicare ID - Type Unspecified
CTH74610Medicare UPIN