Provider Demographics
NPI:1306805999
Name:SHAH, JITENDRA N (MD)
Entity type:Individual
Prefix:MR
First Name:JITENDRA
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3103 HULMEVILLE RD
Mailing Address - Street 2:SUITE #104 JITENDRA SHAH MD
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4365
Mailing Address - Country:US
Mailing Address - Phone:215-638-2344
Mailing Address - Fax:215-638-2346
Practice Address - Street 1:3103 HULMEVILLE RD
Practice Address - Street 2:SUITE #104
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4365
Practice Address - Country:US
Practice Address - Phone:215-638-2344
Practice Address - Fax:215-638-2346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038555L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0780449Medicaid
C32086Medicare UPIN