Provider Demographics
NPI:1285856583
Name:SHAH, RAVISH (MD)
Entity Type:Individual
Prefix:
First Name:RAVISH
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 1:5775 N MEADOWS DR STE D
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7300
Mailing Address - Country:US
Mailing Address - Phone:614-224-4200
Mailing Address - Fax:614-224-4207
Practice Address - Street 1:5775 N MEADOWS DR STE D
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7300
Practice Address - Country:US
Practice Address - Phone:614-224-4200
Practice Address - Fax:614-224-4207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35097802207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052442Medicaid
OHH024001Medicare PIN