Provider Demographics
NPI:1134108103
Name:SHAH, NITIN A (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:A
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 1:44215 15TH ST W
Mailing Address - Street 2:STE 110
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-945-7802
Mailing Address - Fax:661-949-5872
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:STE 110
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-945-7802
Practice Address - Fax:661-949-5872
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33933207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A339330Medicaid
A27303Medicare UPIN
A33933Medicare ID - Type Unspecified