Provider Demographics
NPI:1760479034
Name:SHAH, AMIT BHALCHADRA (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:BHALCHADRA
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 1:25 MONUMENT RD
Mailing Address - Street 2:STE 94
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5049
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:STE 94
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-8180
Practice Address - Fax:717-741-8196
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065685L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50074895OtherCAPITAL BLUE CROSS-WMG
PA211161OtherJOHNS HOPKINS
PA1521040OtherGATEWAY WMG
PA237428OtherUNISON-WMG
PA20069232OtherAMERIHEALTH MERCY-WMG
MD919374OtherCAREFIRST MD BCBS
PA975171OtherHIGHMARK BLUE SHIELD
PA001715857Medicaid
PA7443046OtherAETNA
PA20069232OtherAMERIHEALTH MERCY-WMG
PA211161OtherJOHNS HOPKINS
PAP00672875Medicare PIN