Provider Demographics
NPI:1073791034
Name:SANJAY N SHAH MD INC
Entity Type:Organization
Organization Name:SANJAY N SHAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-343-1900
Mailing Address - Street 1:847 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622
Mailing Address - Country:US
Mailing Address - Phone:330-343-1900
Mailing Address - Fax:330-364-6891
Practice Address - Street 1:847 BOULEVARD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622
Practice Address - Country:US
Practice Address - Phone:330-343-1900
Practice Address - Fax:330-364-6891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANJAY N SHAH MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350370512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9284081Medicaid
OH35086Medicaid
OH9284081Medicaid