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NPI Code Detail

MEDICARE: KANTILAL J. SHAH M.D.

MEDICARE: KANTILAL J. SHAH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD035821LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245341247
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANTILAL J. SHAH M.D.
Provider Business Mailing Address
First Line : PO BOX 820933
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19182-0933
Country : US
Telephone Number : 215-926-9010
Fax Number : 215-226-8285
Provider Business Practice Location Address
First Line : 2701 N BROAD ST
Second Line :
City : PHILA
State : PA
Zip : 19132-2743
Country : US
Telephone Number : 215-226-8800
Fax Number : 215-226-8819
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/19/2011

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