Provider Demographics
NPI:1356750350
Name:SHAH, VAQAR H (MD)
Entity type:Individual
Prefix:
First Name:VAQAR
Middle Name:H
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 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-6469
Mailing Address - Fax:212-342-2496
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6469
Practice Address - Fax:212-342-2496
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289563207RN0300X
WAMD60555059207R00000X
PAMD483432207RN0300X
WI65644-20208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1356750350Medicaid
WI1356750350Medicaid
WISHAVAQOtherMERCYCARE INSURANCE
WAP01557054OtherRR PTAN
WA1356750350Medicaid
WIK400302071-54176Medicare PIN