Provider Demographics
NPI:1023369980
Name:MUSHTAQ A SHAH MD PA
Entity Type:Organization
Organization Name:MUSHTAQ A SHAH MD PA
Other - Org Name:MUSHTAQ SHAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSHTAQ
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-0606
Mailing Address - Street 1:7227 HANOVER PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2025
Mailing Address - Country:US
Mailing Address - Phone:301-220-0606
Mailing Address - Fax:301-513-9049
Practice Address - Street 1:7227 HANOVER PKWY
Practice Address - Street 2:STE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2025
Practice Address - Country:US
Practice Address - Phone:301-220-0606
Practice Address - Fax:301-513-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21843207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC12140001OtherCAREFIRST
DC1043396633OtherINDIVIDUAL NPI
DC414999Medicare PIN