Provider Demographics
NPI:1164698395
Name:SHAH PEDIATRICS,INC
Entity Type:Organization
Organization Name:SHAH PEDIATRICS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARU
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-962-3141
Mailing Address - Street 1:310 PHILIP BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8700
Mailing Address - Country:US
Mailing Address - Phone:770-962-3141
Mailing Address - Fax:
Practice Address - Street 1:310 PHILIP BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8700
Practice Address - Country:US
Practice Address - Phone:770-962-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty