Provider Demographics
NPI:1821094194
Name:SHAH, SAMIR V (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:V
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 95000-5585
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-5585
Mailing Address - Country:US
Mailing Address - Phone:856-667-1575
Mailing Address - Fax:856-946-1747
Practice Address - Street 1:200 BOWMAN DR STE D285
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9626
Practice Address - Country:US
Practice Address - Phone:856-602-4000
Practice Address - Fax:856-210-2849
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07205600207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072857000OtherAMERIHEALTH
NJ3321541OtherAETNA
NJ8622604Medicaid
NJ134233377OtherHORIZON
NJ134233377OtherHORIZON
NJ8622604Medicaid