Provider Demographics
NPI:1194773739
Name:SHAH, DEEPA MALPANI (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:MALPANI
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:MALPANI
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13700-1369
Mailing Address - Street 2:COMMONWEALTH EMERGENCY PHYSICIANS PC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19191-1369
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:44045 RIVERSIDE PARKWAY
Practice Address - Street 2:LOUDOUN HOSPITAL CENTER
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-858-6040
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25276Medicare UPIN
VA009400C77Medicare ID - Type Unspecified