Provider Demographics
NPI:1346229291
Name:SHAHOUD, GEITH H (MD)
Entity Type:Individual
Prefix:
First Name:GEITH
Middle Name:H
Last Name:SHAHOUD
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 1:111 ROBERTS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:GRINDSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:15442-2104
Mailing Address - Country:US
Mailing Address - Phone:724-785-4346
Mailing Address - Fax:724-364-7117
Practice Address - Street 1:111 ROBERTS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-2104
Practice Address - Country:US
Practice Address - Phone:724-785-4346
Practice Address - Fax:724-364-7117
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040097102084P0800X
PAMD4235152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020795770007Medicaid
MO208418608Medicaid
PA1020795770009Medicaid
MOI16240Medicare UPIN
MO208418608Medicaid