Provider Demographics
NPI:1538210109
Name:SHAH, GIRISHKUMAR POPATLAL (MD)
Entity type:Individual
Prefix:
First Name:GIRISHKUMAR
Middle Name:POPATLAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PIPER LN
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3455
Mailing Address - Country:US
Mailing Address - Phone:985-626-1487
Mailing Address - Fax:985-626-8787
Practice Address - Street 1:835 PRIDE DR
Practice Address - Street 2:STE B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-9527
Practice Address - Country:US
Practice Address - Phone:985-543-4333
Practice Address - Fax:985-543-4817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07754R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1914983Medicaid
LA5N968Medicare ID - Type Unspecified
LA1914983Medicaid