Provider Demographics
NPI:1245458801
Name:SAMIR SHAH
Entity type:Organization
Organization Name:SAMIR SHAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-545-3417
Mailing Address - Street 1:401 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-4433
Mailing Address - Country:US
Mailing Address - Phone:724-545-3417
Mailing Address - Fax:724-543-3744
Practice Address - Street 1:401 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-4433
Practice Address - Country:US
Practice Address - Phone:724-545-3417
Practice Address - Fax:724-543-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050641L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035606OtherGATEWAY
PA1790753739OtherTYPE 1 NPI
PAG26631Medicare UPIN
PA1035606OtherGATEWAY