Provider Demographics
NPI:1609970136
Name:MUKUND K SHAH M D INC
Entity Type:Organization
Organization Name:MUKUND K SHAH M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-424-4578
Mailing Address - Street 1:1903 ANN ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2504
Mailing Address - Country:US
Mailing Address - Phone:304-424-4578
Mailing Address - Fax:304-424-4209
Practice Address - Street 1:1903 ANN ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2504
Practice Address - Country:US
Practice Address - Phone:304-424-4578
Practice Address - Fax:304-424-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2713148Medicaid
WV3810005633Medicaid
WV9305471Medicare PIN
OH2713148Medicaid