Healthcare Provider Details

I. General information

NPI: 1457328353
Provider Name (Legal Business Name): REKHA G SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY SUITE 004
COLUMBIA MD
21044-2983
US

IV. Provider business mailing address

11821 CHAPEL ESTATES DR
CLARKSVILLE MD
21029-1164
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-0099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD23645
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: