MEDICARE: DR. SAMIR SURESH 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	207RC0000X	Cardiovascular Disease Physician	069957	GA
2	207RI0011X	Interventional Cardiology Physician	069957	GA
3	207RC0000X	Cardiovascular Disease Physician	MD469351	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447434469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR SURESH SHAH M.D.

Provider Business Mailing Address
First Line	:	3140 PRINCETON PIKE
Second Line	:	2ND FLOOR
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2330
Country	:	US
Telephone Number	:	609-895-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 PRINCETON PIKE FL 2
Second Line	:
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2330
Country	:	US
Telephone Number	:	609-895-1919
Fax Number	:

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	05/24/2021

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