Provider Demographics
NPI:1518009364
Name:SHAH, MOHAMMAD ALI (DO)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ALI
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15807 THISTLEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3289
Mailing Address - Country:US
Mailing Address - Phone:240-723-2855
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE GAITHERSBURG MEDICAL CENTER
Practice Address - Street 2:655 WATKINS MILL RD
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879
Practice Address - Country:US
Practice Address - Phone:202-875-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0077624207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program