Provider Demographics
NPI:1477577666
Name:SHAH, MANZOOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANZOOR
Middle Name:A
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:4400 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4132
Practice Address - Country:US
Practice Address - Phone:717-975-9800
Practice Address - Fax:717-975-5509
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD440396207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477577666OtherNPI
LA2128531Medicaid
LAI65012Medicare UPIN
LA4P728Medicare PIN