Provider Demographics
NPI:1669523213
Name:SHAH, HASMUKH J (MD)
Entity type:Individual
Prefix:DR
First Name:HASMUKH
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HASMUKH
Other - Middle Name:J
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 WOOD POND RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3702
Mailing Address - Country:US
Mailing Address - Phone:860-633-0071
Mailing Address - Fax:
Practice Address - Street 1:100 WOOD POND RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3702
Practice Address - Country:US
Practice Address - Phone:860-633-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT196372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1196377Medicaid
CTD02480Medicare UPIN