Healthcare Provider Details

I. General information

NPI: 1386633212
Provider Name (Legal Business Name): PALLAV N SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

95 HIGHLAND AVE STE 130
BETHLEHEM PA
18017-9483
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-1100
  • Fax: 610-868-1111
Mailing address:
  • Phone: 610-868-1100
  • Fax: 610-868-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number25MA07668100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD422836
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07668100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD422836
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: