Basic Information
| Provider Information | |||||||||
| NPI: | 1760479034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | AMIT | ||||||||
| MiddleName: | BHALCHADRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | STE 94 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | STE 94 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177418180 | ||||||||
| FaxNumber: | 7177418196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD065685L | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 50074895 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 211161 | 01 | PA | JOHNS HOPKINS | OTHER | 1521040 | 01 | PA | GATEWAY WMG | OTHER | 237428 | 01 | PA | UNISON-WMG | OTHER | 20069232 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 919374 | 01 | MD | CAREFIRST MD BCBS | OTHER | 975171 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 001715857 | 05 | PA | MEDICAID | 7443046 | 01 | PA | AETNA | OTHER |