MEDICARE: PAVAN P 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	2085R0202X	Diagnostic Radiology Physician	MD489360	PA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1821626920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAVAN P SHAH MD

Provider Business Mailing Address
First Line	:	132 S 10TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5244
Country	:	US
Telephone Number	:	215-503-4529
Fax Number	:	215-955-5329

Provider Business Practice Location Address
First Line	:	132 S 10TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5244
Country	:	US
Telephone Number	:	215-503-4529
Fax Number	:	215-955-5329

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	05/20/2026

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Directions to “ PAVAN P SHAH MD” Practice Location

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