Provider Demographics
NPI:1336125830
Name:SHAH, MINAXI N (MD)
Entity Type:Individual
Prefix:
First Name:MINAXI
Middle Name:N
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 1:3500 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3224
Mailing Address - Country:US
Mailing Address - Phone:301-645-1133
Mailing Address - Fax:301-645-2369
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-645-1133
Practice Address - Fax:301-645-2369
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188876OtherBCBS VA GROUP PIN FOR PEDIATRIC AFTER HOURS
MD1982753877OtherPEDIATRIC AFTER HOURS GROUP NPI
DC5228-0008OtherBCBS NCA PIN FOR PEDIATRIC AFTER HOURS
MDKH18PE-54406804OtherBCBS MD PIN FOR PEDIATRIC AFTER HOURS
DC5228-0008OtherBCBS NCA PIN FOR PEDIATRIC AFTER HOURS