| Doctor Name: | MUBARIK AHMAD SHAH |
| NPI Number: | 1538152624 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME89362 |
| Business Practice Address: | 6248 Stone Hill Ct Port Tobacco, MD - 206773403 |
| Business Phone Number: | 2679093310 |
| Business Fax Number: | 3019344678 |
| Mailing Address: | 6248 Stone Hill Ct, PORT TOBACCO |
| State: | MD |
| Postal Code: | 206773403 |
| Phone Number: | 2679093310 |
| Fax Number: | 3019344678 |
| NPI Enumeration Date: | 08/24/2005 |
| NPI Last Update Date: | 04/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/25/2006 |
| NPI Reactivation Date: | 10/18/2007 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | ME89362 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |