Provider Demographics
NPI:1679846307
Name:PANKAJ SHAH, M.D., P.A.
Entity Type:Organization
Organization Name:PANKAJ SHAH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-342-3342
Mailing Address - Street 1:8200 WEDNESBURY LN STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2932
Mailing Address - Country:US
Mailing Address - Phone:281-342-3342
Mailing Address - Fax:281-342-0833
Practice Address - Street 1:8200 WEDNESBURY LN STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2932
Practice Address - Country:US
Practice Address - Phone:281-342-3342
Practice Address - Fax:281-342-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9712207RA0201X
TXH9713207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295046101Medicaid
TX295046102Medicaid
TX295046101Medicaid