Provider Demographics
NPI:1578107058
Name:SAMIR M SHAH MD INC
Entity Type:Organization
Organization Name:SAMIR M SHAH MD INC
Other - Org Name:INTOWN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:MAHENDRA
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-675-1637
Mailing Address - Street 1:3009 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1717
Mailing Address - Country:US
Mailing Address - Phone:304-675-1637
Mailing Address - Fax:304-675-2096
Practice Address - Street 1:3009 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1717
Practice Address - Country:US
Practice Address - Phone:304-675-1637
Practice Address - Fax:304-675-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty