Provider Demographics
NPI:1003983065
Name:SHAH, MUKESH VASANTLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:VASANTLAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 112728
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-0328
Mailing Address - Country:US
Mailing Address - Phone:724-489-0523
Mailing Address - Fax:724-489-0321
Practice Address - Street 1:1200 MCKEAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2141
Practice Address - Country:US
Practice Address - Phone:724-489-0523
Practice Address - Fax:724-489-0321
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024125E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008842650006Medicaid
PA197877TZBMedicare ID - Type Unspecified
PA0008842650006Medicaid