Provider Demographics
NPI:1861821258
Name:SHAH, RAKESH K
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 MARFIELD PL
Mailing Address - Street 2:APT--H
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3627
Mailing Address - Country:US
Mailing Address - Phone:410-870-0519
Mailing Address - Fax:
Practice Address - Street 1:7912 MARFIELD PL
Practice Address - Street 2:APT--H
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3627
Practice Address - Country:US
Practice Address - Phone:410-870-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist