Provider Demographics
NPI:1164610481
Name:SHAH N. AFRIDI, M.D., P.A.
Entity Type:Organization
Organization Name:SHAH N. AFRIDI, M.D., P.A.
Other - Org Name:SHAH N. AFRIDI, M.D., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:AFRIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-574-1720
Mailing Address - Street 1:2705 HOSPITAL DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5775
Mailing Address - Country:US
Mailing Address - Phone:361-574-1720
Mailing Address - Fax:361-574-1721
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:STE. 101
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-574-1720
Practice Address - Fax:361-574-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030351301Medicaid
TX030351301Medicaid
TX0A5526Medicare PIN