Provider Demographics
NPI:1285664185
Name:SHAH, RAJIV (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:
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 1:6750 S HIGHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1829
Mailing Address - Country:US
Mailing Address - Phone:801-685-7246
Mailing Address - Fax:801-747-5487
Practice Address - Street 1:6750 S HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-1829
Practice Address - Country:US
Practice Address - Phone:801-685-7246
Practice Address - Fax:801-747-5487
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52-94765-1205207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00050624OtherRAILROAD NUMBER
UTD5067Medicaid
UTH89252Medicare UPIN
UT000059457Medicare PIN