1053674382 NPI number — AMIT A SHAH M.D.

Table of content: AMIT A SHAH M.D. (NPI 1053674382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053674382 NPI number — AMIT A SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
AMIT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053674382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 CIVIC CENTER BOULEVARD
Provider Second Line Business Mailing Address:
7NW41, MAIN HOSPITAL, DIVISION OF GASTROENTEROLOGY
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-590-3247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34TH & CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
9NW55, MAIN HOSPITAL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-1221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MT201276 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0206X , with the licence number: MT201276 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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