Provider Demographics
NPI:1679640387
Name:SHAH, SURESH S (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:S
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 1:269 BERKELEY WAY
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2847
Mailing Address - Country:US
Mailing Address - Phone:412-373-2310
Mailing Address - Fax:412-373-2310
Practice Address - Street 1:269 BERKELEY WAY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2847
Practice Address - Country:US
Practice Address - Phone:412-373-2310
Practice Address - Fax:412-373-2310
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068892L207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001936010OtherHIGHMARK
PA1018467440001Medicaid
PAP00389512Medicare PIN
PA108890Medicare PIN
PAC58034Medicare UPIN