Provider Demographics
NPI:1265683171
Name:SHAH, MINAL M (MD)
Entity Type:Individual
Prefix:
First Name:MINAL
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:23415 THREE NOTCH RD STE 2050
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4018
Mailing Address - Country:US
Mailing Address - Phone:301-373-7800
Mailing Address - Fax:301-373-6800
Practice Address - Street 1:23415 THREE NOTCH RD STE 2050
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-4018
Practice Address - Country:US
Practice Address - Phone:301-373-7800
Practice Address - Fax:301-373-6800
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2021-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0068120207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417273600Medicaid