MEDICARE: GEETA SHAH MD

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	208000000X	Pediatrics Physician	D0020580	MD

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	7614	OTHER	MD	BC/BS OF MD
3	A261245	OTHER	MD	AETNA

General Provider Information

NPI Number	:	1629182688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEETA SHAH MD

Provider Business Mailing Address
First Line	:	2919-D OLNEY SANDY SPRING RD
Second Line	:	OLNEY PROF PARK
City	:	OLNEY
State	:	MD
Zip	:	20832
Country	:	US
Telephone Number	:	301-774-2995
Fax Number	:	301-774-2804

Provider Business Practice Location Address
First Line	:	2919-D OLNEY SANDY SPRING RD
Second Line	:	OLNEY PROF PARK
City	:	OLNEY
State	:	MD
Zip	:	20832
Country	:	US
Telephone Number	:	301-774-2995
Fax Number	:	301-774-2804

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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Directions to “ GEETA SHAH MD” Practice Location

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