1568435725 NPI number — SYED G SHAH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568435725 NPI number — SYED G SHAH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHAH

Provider First Name:

SYED

Provider Middle Name:

G

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1568435725

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/08/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1230 S CEDAR CREST BLVD

Provider Second Line Business Mailing Address:

SUITE 301

Provider Business Mailing Address City Name:

ALLENTOWN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18103-6367

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-432-4529

Provider Business Mailing Address Fax Number:

610-432-2206

Provider First Line Business Practice Location Address:

693 PORT CARBON SAINT CLAIR HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

POTTSVILLE

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17901-8604

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-429-1432

Provider Business Practice Location Address Fax Number:

570-429-1019

Provider Enumeration Date:

02/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD021858E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RN0300X , with the licence number: MD021858E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0000099134 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 020301000 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 19855 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0006506130001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0473231 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 116993900 . This is a "FEDERAL EMPLOYEES COMP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50047349 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 01162201 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0998130 . This is a "KEYSTONE SPECIALIST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 110031030 . This is a "RAILROAD MEDICARE PBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".