Provider Demographics
NPI:1578792420
Name:SHAH, JIGAR ISHWARBHAI (MD)
Entity Type:Individual
Prefix:
First Name:JIGAR
Middle Name:ISHWARBHAI
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8813 WALTHAM WOODS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2450
Mailing Address - Country:US
Mailing Address - Phone:410-661-4670
Mailing Address - Fax:410-661-4671
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2450
Practice Address - Country:US
Practice Address - Phone:410-661-4670
Practice Address - Fax:410-661-4671
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD69540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine