Provider Demographics
NPI:1083691000
Name:SHAH, SAMIR DILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:DILIP
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 1:123 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2769
Mailing Address - Country:US
Mailing Address - Phone:973-579-6300
Mailing Address - Fax:973-579-1524
Practice Address - Street 1:123 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2769
Practice Address - Country:US
Practice Address - Phone:973-579-6300
Practice Address - Fax:973-579-1524
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07085600207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8220808Medicaid
NJ8220808Medicaid
NJ25MA07085600Medicare ID - Type Unspecified