Provider Demographics
NPI:1184839755
Name:SHAH, VIPUL INDULAL (MD)
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:INDULAL
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 1:1203 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2711
Mailing Address - Country:US
Mailing Address - Phone:843-777-2564
Mailing Address - Fax:843-537-2262
Practice Address - Street 1:1203 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2711
Practice Address - Country:US
Practice Address - Phone:843-777-5601
Practice Address - Fax:843-777-5135
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31225207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9690217OtherAETNA
SC064OtherBLUECHOICE
NC5910037Medicaid
SCAA30388552OtherMEDICARE PTAN
SC000000246527OtherUNISON
SC312254Medicaid
SC211192OtherMEDCOST