Provider Demographics
NPI:1285600593
Name:SHAH, SAMIR SUNIL (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:SUNIL
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 LLANFAIR RD
Mailing Address - Street 2:UNIT 6
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2320
Mailing Address - Country:US
Mailing Address - Phone:215-662-3000
Mailing Address - Fax:215-662-7011
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-3000
Practice Address - Fax:215-662-7011
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4244582085R0202X, 2085R0202X
MDD00671732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2620300Medicaid