1598792731 NPI number — DR. DIPAK SHAH MD

Table of content: DR. DIPAK SHAH MD (NPI 1598792731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598792731 NPI number — DR. DIPAK SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
DIPAK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598792731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHAH & ASSOCIATES, LLC
Provider Second Line Business Mailing Address:
P.O. BOX 640
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-373-7900
Provider Business Mailing Address Fax Number:
301-373-6900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHANTI MEDICAL CENTER DIPAK SHAH, MD
Provider Second Line Business Practice Location Address:
26840 POINT LOOKOUT ROAD
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-373-7900
Provider Business Practice Location Address Fax Number:
301-373-6900
Provider Enumeration Date:
06/26/2006

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: 174400000X , with the licence number:  D0054104 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: D0054104 , 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)

  • Identifier: 149802900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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