Provider Demographics
NPI:1295829042
Name:SHAH, INAGANTI MASTAN (MD)
Entity Type:Individual
Prefix:
First Name:INAGANTI
Middle Name:MASTAN
Last Name:SHAH
Suffix:
Gender:M
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:PO BOX 641850
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7850
Mailing Address - Country:US
Mailing Address - Phone:402-572-3535
Mailing Address - Fax:402-572-2688
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:SUITE 2244
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-572-3535
Practice Address - Fax:402-572-2688
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21140207RH0003X
IA33127207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0538751Medicaid
NE47077065413Medicaid
NE830005301OtherRAILROAD MEDICARE NORFOLK
IAP00325300OtherRAILROAD MEDICARE
NE830007286OtherRAILROAD MEDICARE
IA06886Medicare ID - Type Unspecified
IAP00325300OtherRAILROAD MEDICARE
NE271916Medicare ID - Type Unspecified