Provider Demographics
NPI:1770548299
Name:MINASSIAN, SHAHAB S (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHAB
Middle Name:S
Last Name:MINASSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-374-2214
Mailing Address - Fax:610-685-5852
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-374-2214
Practice Address - Fax:610-685-5852
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025615E207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001032180Medicaid
PA171508Medicare PIN
PA001032180Medicaid