Provider Demographics
NPI:1174529101
Name:SHAH, MEHUL N (MD)
Entity type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:170 N HENDERSON RD
Mailing Address - Street 2:STE 302
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2155
Mailing Address - Country:US
Mailing Address - Phone:610-265-8700
Mailing Address - Fax:610-265-1868
Practice Address - Street 1:170 N HENDERSON RD
Practice Address - Street 2:STE 302
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2155
Practice Address - Country:US
Practice Address - Phone:610-265-8700
Practice Address - Fax:610-265-1868
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039894L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000720OtherKEYSTONE MERCY
PA0531867000OtherKEYSTONE
PA0531867000/028516000OtherPERSONAL CHOICE
PA4319575OtherAETNA PPO
PA468245OtherBLUE SHIELD
PA455736/52859OtherAETNA HMO
PAD71652Medicare UPIN
PA468245OtherBLUE SHIELD