MEDICARE: ANKUR RAJU SHAH 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	207RI0011X	Interventional Cardiology Physician	258269	NY
2	207R00000X	Internal Medicine Physician	MD427573	PA
3	207R00000X	Internal Medicine Physician	258269	NY
4	207RC0000X	Cardiovascular Disease Physician	258269	NY

General Provider Information

NPI Number	:	1144411745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANKUR RAJU SHAH M.D.

Provider Business Mailing Address
First Line	:	306 GOLD ST
Second Line	:	APT 24C
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3038
Country	:	US
Telephone Number	:	412-491-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	10012 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2609
Country	:	US
Telephone Number	:	412-491-7611
Fax Number	:	917-300-2785

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

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	07/03/2024

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