Provider Demographics
NPI:1245227735
Name:SHAH, AJIT (MD)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1615 BLACKBURN HEIGHTS DR.
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143
Mailing Address - Country:US
Mailing Address - Phone:412-324-1078
Mailing Address - Fax:142-324-1079
Practice Address - Street 1:800 ROSE ST # HX332E
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-323-5069
Practice Address - Fax:859-257-4457
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036456E2085R0202X
KYTP163207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245227735OtherNPI
KYTP163OtherKENTUCKY MEDICAL LICENSE
1245227735OtherNPI