1083735021 NPI number — ATUL T SHAH MD PA

Table of content: (NPI 1083735021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083735021 NPI number — ATUL T SHAH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATUL T SHAH MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1083735021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2802 GARTH ROAD
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77521-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-422-7970
Provider Business Mailing Address Fax Number:
281-422-7960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 GARTH ROAD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-422-7970
Provider Business Practice Location Address Fax Number:
281-422-7960
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
ATUL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-260-4418

Provider Taxonomy Codes

  • Taxonomy code: 207RI0008X , with the licence number:  J1039 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: J1039 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DG8402 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0066PN . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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