Provider Demographics
NPI:1407848039
Name:SHAH, PRERAK (MD)
Entity Type:Individual
Prefix:
First Name:PRERAK
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:198 MASSACHUSETTS AVE
Mailing Address - Street 2:#103
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-685-7550
Mailing Address - Fax:978-686-5565
Practice Address - Street 1:198 MASSACHUSETTS AVE
Practice Address - Street 2:#103
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-685-7550
Practice Address - Fax:978-686-5565
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA216505207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7 7 03OtherONE HEALTH
973183OtherNETWORK HEALTH
0030238OtherNHP
11882OtherNH LICENSE
191157OtherH PIL
59857OtherFALLON
9495329 001OtherCIGNA PAL
216505OtherMA LICENSE
01Y004790MA01OtherNH BS
43239435OtherHCVM
J26201OtherBS MA
9495329OtherCIGNA
A35450OtherMC
3212109OtherAETNA USHC
48844OtherCHILDRENS MSP
J26201OtherBS HMO
J26201OtherBS HMO
0030238OtherNHP
191157OtherH PIL
J26201OtherBS MA