Provider Demographics
NPI:1093923757
Name:SHAH, AMY GULAB (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GULAB
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12510 PROSPERITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1663
Mailing Address - Country:US
Mailing Address - Phone:240-485-5200
Mailing Address - Fax:
Practice Address - Street 1:5550 FRIENDSHIP BLVD
Practice Address - Street 2:SUITE T-90
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7256
Practice Address - Country:US
Practice Address - Phone:240-737-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101244348207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093923757Medicaid
DC015567ZA15Medicare PIN