MEDICARE: SHANTHARAM PAI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A442860	CA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A442860	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA131554	OTHER	CA	MEDICARE
4	080101190	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A442860	OTHER	CA	BLUE SHIELD OF CA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053317537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTHARAM PAI M.D.

Provider Business Mailing Address
First Line	:	202 E AIRPORT DR STE 130
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3428
Country	:	US
Telephone Number	:	909-799-7111
Fax Number	:	909-498-5154

Provider Business Practice Location Address
First Line	:	202 E AIRPORT DR STE 130
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3428
Country	:	US
Telephone Number	:	909-799-7111
Fax Number	:	909-498-5154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/21/2026

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Directions to “ SHANTHARAM PAI M.D.” Practice Location

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