Provider Demographics
NPI:1265487375
Name:SHAH, ANISH P (DO)
Entity Type:Individual
Prefix:
First Name:ANISH
Middle Name:P
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 HOUMA BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2944
Mailing Address - Country:US
Mailing Address - Phone:504-455-4622
Mailing Address - Fax:504-455-4688
Practice Address - Street 1:4315 HOUMA BLVD STE 305
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2944
Practice Address - Country:US
Practice Address - Phone:504-455-4622
Practice Address - Fax:504-455-4688
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7613207R00000X, 208M00000X
LADO.000006207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186549505Medicaid
TX186549503Medicaid
TX186549504Medicaid
TX186549502Medicaid
TX186549506Medicaid
TXP00673314Medicare PIN
TXTXB155403Medicare PIN
TXTXB162177Medicare PIN
TX8L6177Medicare PIN
TXTXB155404Medicare PIN
TX8L6196Medicare PIN
TX186549504Medicaid
TX3969453YM8AMedicare PIN