Provider Demographics
NPI:1609897065
Name:SHAH, PRAKASHCHANDRA N (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASHCHANDRA
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRAKASH
Other - Middle Name:N
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:247 W MILTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-6689
Mailing Address - Country:US
Mailing Address - Phone:610-258-4891
Mailing Address - Fax:
Practice Address - Street 1:325 PINE ST # EASTON
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4554
Practice Address - Country:US
Practice Address - Phone:610-829-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63811207R00000X
PAMD058780L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102366OtherUNISON HEALTH PLAN
PA20019129OtherAMERIHEALTH MERCY
NY2591762OtherGHI
PAP00081340OtherRAILROAD MEDICARE
PA5717363OtherAETNA
PA001418232OtherHIGH MARK BLUE SHIELD
PA0163134504Medicaid
PA9273540002OtherCIGNA
PA1517097OtherGATEWAY HEALTH PLAN
PA50003488OtherCAPITAL BLUE CROSS
PAP3171345OtherOXFORD HEALTH PLAN
PAP00081340OtherRAILROAD MEDICARE
PA5717363OtherAETNA
PAP3171345OtherOXFORD HEALTH PLAN