MEDICARE: PANKAJ D SHAH MD

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
1	207L00000X	Anesthesiology Physician	35044144	OH
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician	35044144	OH
3	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	35044144	OH
4	207LH0002X	Hospice and Palliative Medicine (Anesthesiology) Physician	35044144	OH
5	207LP2900X	Pain Medicine (Anesthesiology) Physician	35044144	OH
6	207LP3000X	Pediatric Anesthesiology Physician	35044144	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00929255	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0583328	OTHER	OH	BCMH
2	000000221333	OTHER	OH	UNISON
3	000000516062	OTHER	OH	ANTHEM
4	4007903	OTHER	OH	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518969559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANKAJ D SHAH MD

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:	216-383-6614
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-844-7330
Fax Number	:	216-844-3781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	06/30/2011

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Directions to “ PANKAJ D SHAH MD” Practice Location

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