Basic Information
| Provider Information | |||||||||
| NPI: | 1275501793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEVCHIK | ||||||||
| FirstName: | GRANT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 ALLEGHENY AVE | ||||||||
| Address2: | 3 ALLEGHENY PLAZA SUITE 1 | ||||||||
| City: | OAKMONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151392072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124231048 | ||||||||
| FaxNumber: | 4128287580 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 ALLEGHENY AVE | ||||||||
| Address2: | 3 ALLEGHENY PLAZA SUITE 1 | ||||||||
| City: | OAKMONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151392072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124231048 | ||||||||
| FaxNumber: | 4128287580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD02249E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | MD022494E | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000799244 | 05 | PA | MEDICAID |