Provider Demographics
NPI:1508821877
Name:SHAH, RAJESH CHANDRAKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:CHANDRAKANT
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:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-0660
Mailing Address - Country:US
Mailing Address - Phone:724-929-6560
Mailing Address - Fax:724-929-6557
Practice Address - Street 1:515 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1405
Practice Address - Country:US
Practice Address - Phone:724-929-6560
Practice Address - Fax:724-929-6557
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051876L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014819450008Medicaid
PAF83178Medicare UPIN
PA0014819450008Medicaid