Provider Demographics
NPI:1275500639
Name:SHAH, NEETA S (MD)
Entity Type:Individual
Prefix:
First Name:NEETA
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3130
Mailing Address - Fax:508-368-3133
Practice Address - Street 1:340 THOMPSON ROAD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570
Practice Address - Country:US
Practice Address - Phone:508-368-3130
Practice Address - Fax:508-368-3133
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151182207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
784260OtherMVP HEALTH CARE
5467617OtherAETNA
J17076OtherBLUE CARE ELECT
J17076OtherBLUE SHIELD INDEMNITY
042472266OtherONE HEALTH PLAN
2501187OtherEVERCARE
3156770OtherWELFARE
53281OtherCHILDRENS MEDICAL SECURIT
043058466OtherHEALTHCARE VALUE MANAGEME
MA3156770Medicaid
5467617OtherUS HEALTHCARE
J17076OtherBLUE SHIELD HMO BLUE
53281OtherHEALTHY START
9319628OtherCIGNA HEALTH PLAN
29826OtherFIRST HEALTH
AA2841OtherHARVARD PILGRIM HEALTHCAR
J17076OtherBLUE SHIELD HMO BLUE
53281OtherCHILDRENS MEDICAL SECURIT
J17076OtherBLUE CARE ELECT