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General NPI Number Information
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NPI Number | 1245458801
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Entity Type | Organization
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Legal Business Name | SAMIR SHAH
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 401 PINE HILL RD
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City | KITTANNING
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State | PA
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Zip | 16201-4433
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Country | US
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Telephone | 724-545-3417
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Fax | 724-543-3744
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Provider Business Mailing Address
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Address Line | 401 PINE HILL RD
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City | KITTANNING
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State | PA
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Zip | 16201-4433
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Country | US
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Telephone | 724-545-3417
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Fax | 724-543-3744
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. SAMIR J. SHAH
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Credential | M.D.
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Telephone | 724-545-3417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD050641L
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License Number State | PA
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