Provider Demographics
NPI:1114592706
Name:SHAH, RAHUL KETAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:KETAN
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 1:719 THOMPSON LN SOUTH OHO
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3609
Mailing Address - Country:US
Mailing Address - Phone:615-936-1212
Mailing Address - Fax:615-936-9431
Practice Address - Street 1:719 THOMPSON LN SOUTH OHO
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3615
Practice Address - Country:US
Practice Address - Phone:615-936-1212
Practice Address - Fax:615-936-9431
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program