Provider Demographics
NPI:1376669077
Name:VARSHA D. SHAH, M.D.,P.A.
Entity Type:Organization
Organization Name:VARSHA D. SHAH, M.D.,P.A.
Other - Org Name:FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-436-7424
Mailing Address - Street 1:1175 DIANE CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4367
Mailing Address - Country:US
Mailing Address - Phone:972-436-7424
Mailing Address - Fax:
Practice Address - Street 1:1175 DIANE CIR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4367
Practice Address - Country:US
Practice Address - Phone:972-436-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077QFOtherBLUE CROSS
TXC21652Medicare UPIN
TXTXB138756Medicare PIN
TX0077QFOtherBLUE CROSS