Provider Demographics
NPI:1952605578
Name:SAMIRKUMAR J SHAH MD, PC
Entity Type:Organization
Organization Name:SAMIRKUMAR J SHAH MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIRKUMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:412-963-2349
Mailing Address - Street 1:1360 OLD FREEPORT RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:412-963-2349
Mailing Address - Fax:412-963-7568
Practice Address - Street 1:1360 OLD FREEPORT RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-4102
Practice Address - Country:US
Practice Address - Phone:412-963-2349
Practice Address - Fax:412-963-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050641L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4258323Medicare PIN