Provider Demographics
NPI:1174566756
Name:SHAH, PARVEZ I (MD)
Entity type:Individual
Prefix:DR
First Name:PARVEZ
Middle Name:I
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5263
Mailing Address - Country:US
Mailing Address - Phone:301-490-0500
Mailing Address - Fax:301-490-1630
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE 450
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5263
Practice Address - Country:US
Practice Address - Phone:301-490-0500
Practice Address - Fax:301-490-1630
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD18214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200101200Medicaid
MD350M428FMedicare ID - Type UnspecifiedMARYLAND PROVIDER NUMBER
DC410108Medicare ID - Type UnspecifiedPROVIDER NUMBER FOR DC
MD200101200Medicaid