Healthcare Provider Details

I. General information

NPI: 1962792986
Provider Name (Legal Business Name): MANISH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ARMAND HAMMER BLVD STE 300
POTTSTOWN PA
19464-5067
US

IV. Provider business mailing address

508 PRUDENTIAL RD STE 500
HORSHAM PA
19044-2309
US

V. Phone/Fax

Practice location:
  • Phone: 855-235-7246
  • Fax: 215-702-7075
Mailing address:
  • Phone: 855-235-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD455278
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD455278
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: