Healthcare Provider Details

I. General information

NPI: 1831578319
Provider Name (Legal Business Name): MONIL R SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 300
PRINCE FREDERICK MD
20678-4057
US

IV. Provider business mailing address

HSC LEVEL 4, ROOM 176
STONY BROOK NY
11794-8430
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4333
  • Fax: 410-535-3260
Mailing address:
  • Phone: 631-444-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD464011
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: