Provider Demographics
NPI:1629182688
Name:SHAH, GEETA (MD)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919-D OLNEY SANDY SPRING RD
Mailing Address - Street 2:OLNEY PROF PARK
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-774-2995
Mailing Address - Fax:301-774-2804
Practice Address - Street 1:2919-D OLNEY SANDY SPRING RD
Practice Address - Street 2:OLNEY PROF PARK
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-774-2995
Practice Address - Fax:301-774-2804
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020580208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1200290Medicaid
MD7614OtherBC/BS OF MD
MDA261245OtherAETNA