Provider Demographics
NPI:1043209398
Name:SHAH, SAMIR ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:ASHOK
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:401-274-4800
Mailing Address - Fax:401-454-0410
Practice Address - Street 1:44 W RIVER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-274-4800
Practice Address - Fax:401-454-0410
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI9420207RG0100X
MA81704207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1729OtherNEIGHBORHOOD HEALTH PLAN
RI7005825Medicaid
RI400975OtherBLUE CHIP
RI404338OtherTUFTS
RI66429OtherHARVARD PILGRIM
RIG46588Medicare UPIN
RI7005825Medicaid