MEDICARE: DR. RAMESH M. 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	MD024069E	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

General Provider Information

NPI Number	:	1760440853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMESH M. SHAH M.D.

Provider Business Mailing Address
First Line	:	354 STANLEY DR
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-5610
Country	:	US
Telephone Number	:	570-288-3903
Fax Number	:	570-288-3903

Provider Business Practice Location Address
First Line	:	695 E 16TH ST
Second Line	:	SUITE A
City	:	BERWICK
State	:	PA
Zip	:	18603-2320
Country	:	US
Telephone Number	:	570-759-5005
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	06/08/2012

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