Basic Information
| Provider Information | |||||||||
| NPI: | 1245723550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEVCHENKO | ||||||||
| FirstName: | ALINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 NORTH BROAD STREET ROOM 001A | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191404106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1316 WEST ONTARIO STREET | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157073376 | ||||||||
| FaxNumber: | 2157079510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD477049 | PA | Y | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | MT215458 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.