Provider Demographics
NPI:1154510063
Name:PRAKASH SHAH MD INC
Entity Type:Organization
Organization Name:PRAKASH SHAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-762-7272
Mailing Address - Street 1:247 W MILTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-6689
Mailing Address - Country:US
Mailing Address - Phone:610-258-4891
Mailing Address - Fax:610-258-4836
Practice Address - Street 1:185 ROSEBERRY ST
Practice Address - Street 2:WARREN HOSPITAL
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1690
Practice Address - Country:US
Practice Address - Phone:610-258-4891
Practice Address - Fax:610-258-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076107Medicare PIN