Provider Demographics
NPI:1891844981
Name:SHAH, PANKAJ (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-6540
Mailing Address - Fax:
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:OB/GYN DEPT
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0940
Practice Address - Fax:617-770-0526
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA43346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG105OtherHPHC
MA043346OtherTUFTS
MAE05073OtherBCBS
MA0014772OtherNHP
MA7148258-001OtherCIGNA
MA3189805Medicaid
MA0000064Medicare PIN
MAB76695Medicare UPIN