Provider Demographics
NPI:1528039237
Name:SHAH, RAMESH D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:D
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 1:11226 S WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4313
Mailing Address - Country:US
Mailing Address - Phone:819-777-4622
Mailing Address - Fax:819-777-4722
Practice Address - Street 1:2411 FOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4817
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW233OtherBLUE CROSS BLUE SHIELD
TX8K2464OtherBCBS
TX050041750OtherMEDICARE RAILROAD
TX8U3366OtherBLUE CROSS BLUE SHIELD
TX1528039237Medicaid
TX140074925Medicaid
TX140074929Medicaid
LA1982512Medicaid
TX140074929Medicaid
TX140074925Medicaid
TX8AW233OtherBLUE CROSS BLUE SHIELD
LA1982512Medicaid