Individual
KANTILAL J. SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2701 N BROAD ST, PHILA, PA 19132-2743
(215) 226-8800
(215) 226-8819
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 926-9010
(215) 226-8285
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD035821L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000612210
—
PA
Enumeration date
08/31/2006
Last updated
07/19/2011
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