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NPI Code Detail

MEDICARE: ILA SHAH

MEDICARE: ILA SHAH
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
1208000000XPediatrics PhysicianD0015031MD

General Provider Information

NPI Number : 1326067133
Entity Type Code : Individual
Provider Name (Legal Business Name) : ILA SHAH
Provider Business Mailing Address
First Line : 24035 THREE NOTCH RD
Second Line :
City : HOLLYWOOD
State : MD
Zip : 20636-4871
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 37767 MARKET DR
Second Line :
City : CHARLOTTE HALL
State : MD
Zip : 20622-3188
Country : US
Telephone Number : 301-884-7330
Fax Number : 301-884-8663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 10/15/2007

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Directions to “ ILA SHAH ” Practice Location

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