Provider Demographics
NPI:1528029725
Name:SHAH, JAGDISH R (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-0339
Mailing Address - Country:US
Mailing Address - Phone:717-697-4980
Mailing Address - Fax:717-697-4979
Practice Address - Street 1:1700 BENT CREEK BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1870
Practice Address - Country:US
Practice Address - Phone:717-697-4980
Practice Address - Fax:717-697-4979
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4267762084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093815Medicare PIN