Provider Demographics
NPI:1417992447
Name:SHAH, SHITAL (MD)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:
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 1:2501 OREGON PK.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4890
Mailing Address - Country:US
Mailing Address - Phone:717-293-3223
Mailing Address - Fax:717-390-2455
Practice Address - Street 1:89 SPARTA AVE.
Practice Address - Street 2:SUITE 120
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:973-729-0002
Practice Address - Fax:973-726-4456
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2140282085R0202X
NJ25MA082491002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0188131Medicaid
NJ0188131Medicaid
NJ147438ACLMedicare PIN
NJ147438A3HMedicare PIN