Provider Demographics
NPI:1548295637
Name:SHAH, ASMITA C (MD)
Entity type:Individual
Prefix:DR
First Name:ASMITA
Middle Name:C
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:827 OLEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:18661-3043
Mailing Address - Country:US
Mailing Address - Phone:570-443-4328
Mailing Address - Fax:570-443-4143
Practice Address - Street 1:827 OLEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:WHITE HAVEN
Practice Address - State:PA
Practice Address - Zip Code:18661-3043
Practice Address - Country:US
Practice Address - Phone:570-443-4328
Practice Address - Fax:570-443-4143
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033055E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF52986Medicare UPIN
PA736907Medicare ID - Type Unspecified