Provider Demographics
NPI:1356512891
Name:SHABBIR LAKDAWALA, MD PC
Entity type:Organization
Organization Name:SHABBIR LAKDAWALA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHABBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKDAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-563-1132
Mailing Address - Street 1:2912 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2042
Mailing Address - Country:US
Mailing Address - Phone:412-563-1132
Mailing Address - Fax:412-561-2117
Practice Address - Street 1:2912 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2042
Practice Address - Country:US
Practice Address - Phone:412-563-1132
Practice Address - Fax:412-561-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037979L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014014250001Medicaid
B41344Medicare UPIN
PA410454Medicare PIN