Provider Demographics
NPI:1194940973
Name:SHAH, ANAND R (MD)
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-3916
Mailing Address - Fax:214-648-8423
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-648-3916
Practice Address - Fax:214-648-8423
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4379207P00000X
RILP00449207P00000X
RIMD13025207P00000X
PAMD440167207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082857AMedicaid
RI07/01/2009OtherUNITED HEALTHCARE
MA10/27/2009OtherTUFTS HEALTH PLAN
RIAS76190Medicaid
RI10/13/2009OtherNHPRI
RI07/30/2009OtherBCBS
RI1194940973OtherNPI
RI1962455022OtherUEMF NPI GROUP NUMBER
RI939025129OtherRI MEDICARE GROUP
RI001258201OtherMEDICARE