Individual
SHIVAM SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(484) 565-1596
(610) 889-0813
Mailing address
PO BOX 678678, DALLAS, TX 75267-8678
(800) 475-6112
(423) 826-1286
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD472121
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD472121
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1D6795
—
PA
05
—
1D6800
—
PA
Enumeration date
04/17/2014
Last updated
10/01/2020
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