Provider Demographics
NPI:1235172651
Name:SHAH, RAHIL DEVENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHIL
Middle Name:DEVENDRA
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1014 SAINT CLAIR BLVD STE 3030
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5023
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-743-2546
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039491207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2153382Medicaid
TNI29683Medicare UPIN
LA4Q201Medicare PIN