Provider Demographics
NPI:1154376713
Name:SHAH, CHANDRAKANT C (MD)
Entity type:Individual
Prefix:
First Name:CHANDRAKANT
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-1467
Mailing Address - Country:US
Mailing Address - Phone:610-369-0913
Mailing Address - Fax:610-369-0917
Practice Address - Street 1:23 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1300
Practice Address - Country:US
Practice Address - Phone:610-369-0913
Practice Address - Fax:610-367-8418
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038812L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000406783OtherHIGHMARK
01227301OtherCBC
PA0015083320001Medicaid
PA0007687760006Medicaid
PA0015083320001Medicaid
PA0007687760006Medicaid