Provider Demographics
NPI:1831298405
Name:SHAH, SYED M (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2500 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 321
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6469
Mailing Address - Country:US
Mailing Address - Phone:919-787-5340
Mailing Address - Fax:919-787-5048
Practice Address - Street 1:2500 BLUE RIDGE RD
Practice Address - Street 2:SUITE 321
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6469
Practice Address - Country:US
Practice Address - Phone:919-787-5340
Practice Address - Fax:919-787-5048
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2017-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC38884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7975403Medicaid
E67512Medicare UPIN
NC7975403Medicaid