1689805566 NPI number — KUNAL SHAH

Table of content: KUNAL SHAH (NPI 1689805566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689805566 NPI number — KUNAL SHAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
KUNAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1689805566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 CALLA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21015-1640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-278-4174
Provider Business Mailing Address Fax Number:
410-939-7780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 ST. JOHN ST
Provider Second Line Business Practice Location Address:
LYON'S PHARMACY
Provider Business Practice Location Address City Name:
HAVRE DE GRACE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-939-4545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2009

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: 183500000X , with the licence number:  18116 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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