Provider Demographics
NPI:1528092657
Name:SHAH, ANISH U (MD)
Entity type:Individual
Prefix:
First Name:ANISH
Middle Name:U
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:79 WAWECUS STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-886-0161
Mailing Address - Fax:860-889-5999
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-886-0161
Practice Address - Fax:860-889-5999
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT038917207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
772141OtherCONNECTICARE
P2130992OtherOXFORD
CTOV7949OtherHEALTH NET
190466OtherPREFERRED ONE
2435963OtherAETNA
0804947OtherUNITED HEALTHCARE
1531207002OtherCIGNA
CT001389172Medicaid
CT010038917CT01OtherBCS
CT010038917CT01OtherBCS
CT001389172Medicaid
CTOV7949OtherHEALTH NET