Healthcare Provider Details

I. General information

NPI: 1285688572
Provider Name (Legal Business Name): KARTIK J. SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION ROAD
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

4 NESHAMINY INTERPLEX SUITE 209
TREVOSE PA
19053-6940
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4021
  • Fax:
Mailing address:
  • Phone: 215-244-3070
  • Fax: 215-638-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD423540
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD423540
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD423540
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD423540
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD423540
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD423540
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: