Healthcare Provider Details

I. General information

NPI: 1750720827
Provider Name (Legal Business Name): NISHIT P SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST MAIL STOP 427
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

2979 W SCHOOL HOUSE LN APT K810
PHILADELPHIA PA
19144-5401
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7698
  • Fax:
Mailing address:
  • Phone: 312-208-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT-205191
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.127962
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.127962
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: