Healthcare Provider Details

I. General information

NPI: 1871977793
Provider Name (Legal Business Name): PRATIK SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 BANK CT
FREDERICK MD
21703-8483
US

IV. Provider business mailing address

PO BOX 37086
BALTIMORE MD
21297-3086
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-7830
  • Fax:
Mailing address:
  • Phone: 240-439-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA13211100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD89673
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: