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General NPI Number Information
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NPI Number | 1053674382
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Entity Type | Individual
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Provider Name | AMIT A SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 34TH & CIVIC CENTER BLVD 9NW55, MAIN HOSPITAL
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-590-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 CIVIC CENTER BOULEVARD 7NW41, MAIN HOSPITAL, DIVISION OF GASTROENTEROLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-590-3247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT201276
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | MT201276
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License Number State | PA
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