Basic Information
| Provider Information | |||||||||
| NPI: | 1194940973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | ANAND | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 845347 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752845347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146483916 | ||||||||
| FaxNumber: | 2146488423 | ||||||||
| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146483916 | ||||||||
| FaxNumber: | 2146488423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 11/13/2012 | ||||||||
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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 | 207P00000X | P4379 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | LP00449 | RI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD13025 | RI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD440167 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110082857A | 05 | MA | MEDICAID | 07/01/2009 | 01 | RI | UNITED HEALTHCARE | OTHER | 10/27/2009 | 01 | MA | TUFTS HEALTH PLAN | OTHER | AS76190 | 05 | RI | MEDICAID | 10/13/2009 | 01 | RI | NHPRI | OTHER | 07/30/2009 | 01 | RI | BCBS | OTHER | 1194940973 | 01 | RI | NPI | OTHER | 1962455022 | 01 | RI | UEMF NPI GROUP NUMBER | OTHER | 939025129 | 01 | RI | RI MEDICARE GROUP | OTHER | 001258201 | 01 | RI | MEDICARE | OTHER |