Provider Demographics
NPI:1790753739
Name:SHAH, SAMIRKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIRKUMAR
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMIRKUMAR
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:401 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-4425
Mailing Address - Country:US
Mailing Address - Phone:724-545-3417
Mailing Address - Fax:724-543-3744
Practice Address - Street 1:401 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-4425
Practice Address - Country:US
Practice Address - Phone:724-545-3417
Practice Address - Fax:724-543-3744
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050641L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA817870Medicare PIN
PAG26631Medicare UPIN