Provider Demographics
NPI:1871881599
Name:HEIDELBERGER, PRIYANKI SHAH (MD)
Entity type:Individual
Prefix:
First Name:PRIYANKI
Middle Name:SHAH
Last Name:HEIDELBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRIYANKI
Other - Middle Name:RASHMIKANT
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-7315
Mailing Address - Fax:
Practice Address - Street 1:2350 FREEDOM WAY STE 150
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-7315
Practice Address - Fax:727-741-3056
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102973643 0001Medicaid
PA1029736430002Medicaid