Provider Demographics
NPI:1760440853
Name:SHAH, RAMESH M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:M
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 1:354 STANLEY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5610
Mailing Address - Country:US
Mailing Address - Phone:570-288-3903
Mailing Address - Fax:570-288-3903
Practice Address - Street 1:695 E 16TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2320
Practice Address - Country:US
Practice Address - Phone:570-759-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024069E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015204000001Medicaid
PA098872Medicare ID - Type Unspecified
PA109694Medicare PIN
PA1015204000001Medicaid