MEDICARE: PATHIK SHAH DMD

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	1223G0001X	General Practice Dentistry	DS041694	PA

General Provider Information

NPI Number	:	1629477815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATHIK SHAH DMD

Provider Business Mailing Address
First Line	:	6818 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2106
Country	:	US
Telephone Number	:	215-742-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6818 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2106
Country	:	US
Telephone Number	:	240-630-2435
Fax Number	:

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

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	05/14/2021

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Directions to “ PATHIK SHAH DMD” Practice Location

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