Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD442736 | PA |
NPI | 1023148731 |
---|---|
Provider Name | Nirav R. Shah |
First Address | Wyomissing, PA 19610-2002 |
Second Address | Wyomissing, PA 19610-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I69794 | (02) | PA |