Provider Demographics
NPI:1275671117
Name:SHAH, KRISHNAJIVAN CHHABILDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNAJIVAN
Middle Name:CHHABILDAS
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISHNA
Other - Middle Name:C
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M,D,
Mailing Address - Street 1:466 IRISH ST
Mailing Address - Street 2:P.O.BOX 903
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1818
Mailing Address - Country:US
Mailing Address - Phone:304-872-3010
Mailing Address - Fax:304-872-3010
Practice Address - Street 1:466 IRISH ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1818
Practice Address - Country:US
Practice Address - Phone:304-872-3010
Practice Address - Fax:304-872-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV157382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology