Provider Demographics
NPI:1750362380
Name:SHAH, ZIA H (MD)
Entity type:Individual
Prefix:DR
First Name:ZIA
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 1:161 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-797-6363
Mailing Address - Fax:866-546-2496
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE M 09
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-797-6363
Practice Address - Fax:866-546-2496
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199773207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01643594Medicaid
NYF74962Medicare UPIN