Provider Demographics
NPI:1588822977
Name:SHAH, ASHESH PIYUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHESH
Middle Name:PIYUSH
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1100 WALNUT STREET
Mailing Address - Street 2:MOB, 5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4944
Mailing Address - Country:US
Mailing Address - Phone:215-955-6750
Mailing Address - Fax:215-923-8222
Practice Address - Street 1:1100 WALNUT ST
Practice Address - Street 2:MOB, 5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4944
Practice Address - Country:US
Practice Address - Phone:215-955-6750
Practice Address - Fax:215-923-8222
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062356A208600000X
PAMD447645208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery