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General NPI Number Information
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NPI Number | 1528029725
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Entity Type | Individual
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Provider Name | JAGDISH R. SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 1700 BENT CREEK BLVD SUITE 150
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City | MECHANICSBURG
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State | PA
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Zip | 17050-1870
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Country | US
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Telephone | 717-697-4980
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Fax | 717-697-4979
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | MECHANICSBURG
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State | PA
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Zip | 17055-0339
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Country | US
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Telephone | 717-697-4980
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Fax | 717-697-4979
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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 | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | MD426776
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License Number State | PA
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