Provider Demographics
NPI:1588637664
Name:BAKSH, SHASHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:
Last Name:BAKSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2415
Mailing Address - Country:US
Mailing Address - Phone:717-393-7771
Mailing Address - Fax:717-393-7328
Practice Address - Street 1:2301 HARRISBURG PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2415
Practice Address - Country:US
Practice Address - Phone:717-393-7771
Practice Address - Fax:717-393-7328
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065880L207ZP0102X
PA39D1074950291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001920947Medicaid
PA1205026002OtherNPI
PA059648Medicare PIN
PA120165Medicare PIN
PA001920947Medicaid