Provider Demographics
NPI:1659459543
Name:LOH, SHANG A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANG
Middle Name:A
Last Name:LOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MARKET ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5544
Mailing Address - Country:US
Mailing Address - Phone:215-662-9660
Mailing Address - Fax:215-243-4649
Practice Address - Street 1:3737 MARKET ST FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5544
Practice Address - Country:US
Practice Address - Phone:215-662-9660
Practice Address - Fax:215-243-4649
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4743482086S0129X
CAA930702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A930700Medicaid
I50197Medicare UPIN
00A930700Medicare ID - Type Unspecified