Provider Demographics
NPI:1922014851
Name:SHAH, SAMIR BIPIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:BIPIN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LENNON LANE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-296-6100
Mailing Address - Fax:925-646-0148
Practice Address - Street 1:301 LENNON LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-296-6100
Practice Address - Fax:925-932-1160
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA68255207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH42837Medicare UPIN
CAYYY439057YMedicare ID - Type Unspecified