Provider Demographics
NPI:1043366693
Name:SHAH, NAVIN P (MD)
Entity Type:Individual
Prefix:
First Name:NAVIN
Middle Name:P
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 1:211 CHURCHILL FARMS DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7897
Mailing Address - Country:US
Mailing Address - Phone:615-904-6854
Mailing Address - Fax:
Practice Address - Street 1:211 CHURCHILL FARMS DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-7897
Practice Address - Country:US
Practice Address - Phone:615-904-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000198922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3046955Medicaid
TN3046958Medicare ID - Type Unspecified
TN3046955Medicaid