Provider Demographics
NPI:1346230109
Name:SHAH, VINODRAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:VINODRAY
Middle Name:R
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 1:1221 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5396
Mailing Address - Country:US
Mailing Address - Phone:413-532-0464
Mailing Address - Fax:413-532-7652
Practice Address - Street 1:50 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1634
Practice Address - Country:US
Practice Address - Phone:413-567-9681
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47114208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0144894Medicaid
MAB97644Medicare UPIN
MAH 10161Medicare ID - Type Unspecified