Provider Demographics
NPI:1558355750
Name:SHAH, DARSHAN J (MD)
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:J
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 1:139 HAZARD AVE
Mailing Address - Street 2:BLDG 4, SUITE # 14
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4585
Mailing Address - Country:US
Mailing Address - Phone:860-763-0208
Mailing Address - Fax:860-763-0224
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BLDG 4, SUITE # 14
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-763-0208
Practice Address - Fax:860-763-0224
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1384792Medicaid
CT138479200OtherBLUECARE FAMILY PLAN
CT7287123OtherAETNA
CT01038479OtherCIGNA
CTP2097192OtherOXFORD HEALTH PLANS
CT0100384479-CT01OtherBCBS
CT038479OtherCONNECTICARE
CT0V7377OtherHEALTH NET
CT61373363OtherUNITED HEALTH CARE
CT110007936Medicare ID - Type Unspecified
CT0V7377OtherHEALTH NET