Provider Demographics
NPI:1275547234
Name:SHAH, LATA (MD)
Entity Type:Individual
Prefix:DR
First Name:LATA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
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:LUNG AND SLEEP CLINIC (D/B/A)
Mailing Address - Street 2:1112 EAST MAIN STREET
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-2808
Mailing Address - Country:US
Mailing Address - Phone:423-293-3711
Mailing Address - Fax:423-293-3900
Practice Address - Street 1:LUNG AND SLEEP CLINIC
Practice Address - Street 2:1112 EAST MAIN STREET
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2808
Practice Address - Country:US
Practice Address - Phone:423-293-3711
Practice Address - Fax:423-293-3900
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN41496207R00000X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024218Medicaid
TN103G477120Medicare PIN
TN103I291288Medicare PIN
TNP00421951Medicare PIN
TN103I292870Medicare PIN