Basic Information
Provider Information
NPI: 1174819361
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOSHI
FirstName: NEIL
MiddleName: RAMESH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 51 N 39TH ST
Address2: MAB SUITE 102
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156629990
FaxNumber:  
Practice Location
Address1: 230 N BROAD ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191021121
CountryCode: US
TelephoneNumber: 2157627000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2011
LastUpdateDate: 01/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD452794PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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