Provider Demographics
NPI:1205968757
Name:SHAH, NEERAJ B (MD)
Entity type:Individual
Prefix:
First Name:NEERAJ
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E RIVERSIDE DR APT 74214
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-0068
Mailing Address - Country:US
Mailing Address - Phone:512-814-5215
Mailing Address - Fax:512-628-3277
Practice Address - Street 1:305 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3006
Practice Address - Country:US
Practice Address - Phone:512-814-5215
Practice Address - Fax:512-628-3277
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96977207R00000X
TXN1889207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209495506Medicaid
TX209495505Medicaid
TX209495504Medicaid
TX209495503Medicaid
TXTXB145152Medicare PIN
TXTXB155182Medicare PIN
TX209495503Medicaid
TXTXB145151Medicare PIN
TXTXB155183Medicare PIN
TXP01241202Medicare PIN