Provider Demographics
NPI:1316178072
Name:MAHIPAL M. SHAH, M.D.,P.C.
Entity Type:Organization
Organization Name:MAHIPAL M. SHAH, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIPAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-626-1955
Mailing Address - Street 1:4950 SAN BERNARDINO ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2328
Mailing Address - Country:US
Mailing Address - Phone:909-626-1955
Mailing Address - Fax:909-626-1141
Practice Address - Street 1:4950 SAN BERNARDINO ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:909-626-1955
Practice Address - Fax:909-626-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty