Provider Demographics
NPI:1912292970
Name:SHAH, SARAH R (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P. O. BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-632-4000
Mailing Address - Fax:215-632-1661
Practice Address - Street 1:10101 ACADEMY ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1120
Practice Address - Country:US
Practice Address - Phone:215-632-4000
Practice Address - Fax:215-632-1661
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS016551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA353416YUNMMedicare PIN
PA353416YEBKMedicare PIN