Provider Demographics
NPI:1033285648
Name:SHAH, PADMAKANT M (MD)
Entity Type:Individual
Prefix:
First Name:PADMAKANT
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BELLAMY LOOP
Mailing Address - Street 2:CO OP CITY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3702
Mailing Address - Country:US
Mailing Address - Phone:718-671-6600
Mailing Address - Fax:718-671-6600
Practice Address - Street 1:140 BELLAMY LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3702
Practice Address - Country:US
Practice Address - Phone:718-671-6600
Practice Address - Fax:718-671-6600
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY120709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00268364Medicaid
NY0090942OtherGHI
NY00268364Medicaid
C08294Medicare UPIN