Basic Information
| Provider Information | |||||||||
| NPI: | 1629049036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMANULLAH | ||||||||
| FirstName: | SHAKEEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | SUITE 244 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175447679 | ||||||||
| FaxNumber: | 7175444964 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | SUITE 244 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444930 | ||||||||
| FaxNumber: | 7175444964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD422116 | PA | N | Other Service Providers | Specialist | 207RC0200X | 01064290A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200872750 | 05 | IN | MEDICAID | 101294097 | 05 | PA | MEDICAID | 000000531300 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER |