Provider Demographics
NPI:1083735021
Name:ATUL T SHAH MD PA
Entity Type:Organization
Organization Name:ATUL T SHAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-260-4418
Mailing Address - Street 1:2802 GARTH ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3924
Mailing Address - Country:US
Mailing Address - Phone:281-422-7970
Mailing Address - Fax:281-422-7960
Practice Address - Street 1:2802 GARTH ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3924
Practice Address - Country:US
Practice Address - Phone:281-422-7970
Practice Address - Fax:281-422-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1039207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG8402OtherRAILROAD MEDICARE
TX0066PNOtherBCBS
TXDG8402OtherRAILROAD MEDICARE
TXF03012Medicare UPIN