Provider Demographics
NPI:1255327300
Name:SHAH, BIMAL RAMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:BIMAL
Middle Name:RAMESH
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 1:5 SYDENHAM RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7211
Mailing Address - Country:US
Mailing Address - Phone:919-321-6829
Mailing Address - Fax:
Practice Address - Street 1:5 SYDENHAM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7211
Practice Address - Country:US
Practice Address - Phone:919-321-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00907207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34083Medicare UPIN
2047669BMedicare ID - Type UnspecifiedMEDICARE