Provider Demographics
NPI:1750333993
Name:SHAH, DIPEN R (MD)
Entity Type:Individual
Prefix:MR
First Name:DIPEN
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:431 KEISLER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7064
Mailing Address - Country:US
Mailing Address - Phone:919-468-6820
Mailing Address - Fax:919-468-6484
Practice Address - Street 1:431 KEISLER DR STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7064
Practice Address - Country:US
Practice Address - Phone:919-468-6820
Practice Address - Fax:919-468-6484
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902201Medicaid
14063OtherBCBS
I01054Medicare UPIN
NC2041362CMedicare PIN