Provider Demographics
NPI:1619186202
Name:SHAH, MANISH DHIRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:DHIRAJ
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 SAINT PAUL PL
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-951-7969
Mailing Address - Fax:410-576-5499
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-951-7969
Practice Address - Fax:410-576-5499
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0067476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211NMedicare PIN