Healthcare Provider Details

I. General information

NPI: 1891844981
Provider Name (Legal Business Name): PANKAJ SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST OB/GYN DEPT
QUINCY MA
02169-4339
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-0940
  • Fax: 617-770-0526
Mailing address:
  • Phone: 617-421-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43346
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: