Provider Demographics
NPI:1609934330
Name:SHAH, VIPUL B (MD)
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9134
Mailing Address - Country:US
Mailing Address - Phone:717-632-2088
Mailing Address - Fax:717-637-9482
Practice Address - Street 1:2201 BRUNSWICK DR STE 1300
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8350
Practice Address - Country:US
Practice Address - Phone:717-632-2088
Practice Address - Fax:717-646-7428
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020489640001Medicaid
OH2509048Medicaid
PA119797Medicare PIN
I16292Medicare UPIN