Healthcare Provider Details

I. General information

NPI: 1356750350
Provider Name (Legal Business Name): VAQAR H SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8885
  • Fax: 717-531-4645
Mailing address:
  • Phone: 717-531-8156
  • Fax: 717-531-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number289563
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number65644-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD483432
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1356750350
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
IdentifierP01557054
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerRR PTAN
# 3
IdentifierSHAVAQ
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerMERCYCARE INSURANCE
# 4
Identifier1356750350
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: