Provider Demographics
NPI:1679768733
Name:SHAH, ANITA T (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:T
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 1:2200 ST LUKE'S BLVD
Mailing Address - Street 2:PHYSICIAN BILLING
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045
Mailing Address - Country:US
Mailing Address - Phone:484-503-0060
Mailing Address - Fax:
Practice Address - Street 1:2200 ST LUKE'S BLVD
Practice Address - Street 2:PHYSICIAN BILLING
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:484-503-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics