Basic Information
Provider Information | |||||||||
NPI: | 1376922930 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHAH | ||||||||
FirstName: | MUHAMMAD | ||||||||
MiddleName: | KUMAIL | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20 YORK STREET, CB-329 | ||||||||
Address2: |   | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 065103220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2036881734 | ||||||||
FaxNumber: | 2036889638 | ||||||||
Practice Location | |||||||||
Address1: | 5 PERRYRIDGE RD | ||||||||
Address2: |   | ||||||||
City: | GREENWICH | ||||||||
State: | CT | ||||||||
PostalCode: | 068304608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2038632800 | ||||||||
FaxNumber: | 2038634647 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/28/2015 | ||||||||
LastUpdateDate: | 06/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.145161 | IL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 208M00000X | 17068 | ND | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208M00000X | 67571 | CT | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.