Provider Demographics
NPI:1497783591
Name:SHAH, MAHESH G (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:G
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 1:431 S. BATAVIA ST SUITE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-288-1012
Mailing Address - Fax:714-288-0843
Practice Address - Street 1:431 S. BATAVIA ST SUITE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-288-1012
Practice Address - Fax:714-288-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49070Medicare ID - Type Unspecified
CAE83310Medicare UPIN
CAE82210Medicare UPIN