Provider Demographics
NPI:1700087582
Name:SHAH, ANAND M (MD)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:647 W AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3893
Mailing Address - Country:US
Mailing Address - Phone:661-949-8643
Mailing Address - Fax:661-947-1631
Practice Address - Street 1:647 W AVENUE Q
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3893
Practice Address - Country:US
Practice Address - Phone:661-949-8643
Practice Address - Fax:661-947-1631
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98966207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6199600001Medicare NSC