Provider Demographics
NPI:1548257769
Name:SHAH, GITA K
Entity type:Individual
Prefix:MRS
First Name:GITA
Middle Name:K
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5268
Mailing Address - Country:US
Mailing Address - Phone:301-604-8000
Mailing Address - Fax:301-604-4406
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5268
Practice Address - Country:US
Practice Address - Phone:301-604-8000
Practice Address - Fax:301-604-4406
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020251207RI0200X
MDM07210207RI0200X
MDAS9323522207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD50310001OtherBCDC
MD86305OtherMDIPA
MD86305OtherMDIPA
MD00B780I79Medicare ID - Type Unspecified
C62530Medicare UPIN