Provider Demographics
NPI:1033165261
Name:SHAH, BANSI P (MD)
Entity Type:Individual
Prefix:
First Name:BANSI
Middle Name:P
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1404
Mailing Address - Country:US
Mailing Address - Phone:336-768-3530
Mailing Address - Fax:336-768-1329
Practice Address - Street 1:3318 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1404
Practice Address - Country:US
Practice Address - Phone:336-768-3530
Practice Address - Fax:336-768-1329
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17432208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4098739OtherAETNA
NC8975396Medicaid
NC1022OtherPARTNERS
147909OtherTRIGON
73-0902-3OtherVA MEDICAID
NC75396OtherBCBSNC
NC75396OtherBCBSNC
NC8975396Medicaid