Provider Demographics
NPI:1053931410
Name:SHAH, PIR ALI (MD)
Entity type:Individual
Prefix:MR
First Name:PIR
Middle Name:ALI
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVENUE SOUTHEAST ROBERT C. BIND CLINICAL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5590
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:3200 MACCORKLE AVENUE SOUTHEAST ROBERT C. BIND CLINICAL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5590
Practice Address - Fax:304-388-8238
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2022-02-03
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2022-02-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program