MEDICARE: TRUSHIL GAURAV 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	207RP1001X	Pulmonary Disease Physician	14659320	WI
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME176331	FL
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD487199C	PA
4	207R00000X	Internal Medicine Physician	MD487199C	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XH197	OTHER	FL	HFMG

General Provider Information

NPI Number	:	1417260399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUSHIL GAURAV SHAH M.D.

Provider Business Mailing Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-707-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 E WYOMING AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-3808
Country	:	US
Telephone Number	:	215-707-1622
Fax Number	:	215-707-0943

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	05/10/2026

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Directions to “ TRUSHIL GAURAV SHAH M.D.” Practice Location

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