Individual
MR. HETAL S SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 ROUTE 70 EAST, SUTIE G-101, MARLTON, NJ 08053-2345
(856) 983-9939
(856) 983-9936
Mailing address
777 ROUTE 70 EAST, SUITE G-101, MARLTON, NJ 08053-2345
(856) 983-9939
(856) 983-9936
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA07503100
NJ
207Q00000X
Family Medicine Physician
MA075031
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0045047
—
NJ
01
—
240537
AMERIGROUP
NJ
01
—
7876554
AETNA
NJ
Enumeration date
07/03/2006
Last updated
11/25/2014
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