Provider Demographics
NPI:1093701591
Name:LAKDAWALA, SHABBIR S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABBIR
Middle Name:S
Last Name:LAKDAWALA
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 1:2912 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2042
Mailing Address - Country:US
Mailing Address - Phone:412-563-1132
Mailing Address - Fax:412-561-2117
Practice Address - Street 1:2912 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2042
Practice Address - Country:US
Practice Address - Phone:412-563-1132
Practice Address - Fax:412-561-2117
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037979L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007711540001Medicaid
PA410454Medicare ID - Type Unspecified
PA0007711540001Medicaid