Provider Demographics
NPI:1649496837
Name:SHAMSHER BAKTH, M.D.P.C.
Entity type:Organization
Organization Name:SHAMSHER BAKTH, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-466-8088
Mailing Address - Street 1:PO BOX 81680
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-0480
Mailing Address - Country:US
Mailing Address - Phone:412-466-8088
Mailing Address - Fax:412-466-8298
Practice Address - Street 1:500 LEWIS RUN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15122-3056
Practice Address - Country:US
Practice Address - Phone:412-466-8088
Practice Address - Fax:412-466-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035910-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1050956Medicaid
PA072407OtherKEYSTONE PROVIDER
PAB34967Medicare UPIN
PA1050956Medicaid