Provider Demographics
NPI:1417156902
Name:SHAH, MAUNANK R (MD)
Entity Type:Individual
Prefix:
First Name:MAUNANK
Middle Name:R
Last Name:SHAH
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 1:3108 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3931
Mailing Address - Country:US
Mailing Address - Phone:410-350-9513
Mailing Address - Fax:
Practice Address - Street 1:222 E SARATOGA ST
Practice Address - Street 2:APT 905
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3512
Practice Address - Country:US
Practice Address - Phone:404-247-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT2681207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418284700Medicaid
MD418284700Medicaid