Provider Demographics
NPI:1881717627
Name:SHAH ASSOCIATES MD PA
Entity type:Organization
Organization Name:SHAH ASSOCIATES MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-373-7500
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0640
Mailing Address - Country:US
Mailing Address - Phone:301-373-7500
Mailing Address - Fax:301-373-6500
Practice Address - Street 1:24035 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-4871
Practice Address - Country:US
Practice Address - Phone:301-373-7500
Practice Address - Fax:301-373-6500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAH ASSOCIATES MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD201373700Medicaid
MD490001599OtherMEDICARE RAILROAD
MD490001599OtherMEDICARE RAILROAD