Healthcare Provider Details

I. General information

NPI: 1245206309
Provider Name (Legal Business Name): DR. RAJESH M SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST
BALTIMORE MD
21201-4648
US

IV. Provider business mailing address

821 N EUTAW ST STE 305
BALTIMORE MD
21201-6303
US

V. Phone/Fax

Practice location:
  • Phone: 410-669-1393
  • Fax:
Mailing address:
  • Phone: 443-321-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD62241
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD62241
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD62241
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD062241
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: