Provider Demographics
NPI:1376535328
Name:SHAH, VATSALA NIRANJAN (MD)
Entity Type:Individual
Prefix:
First Name:VATSALA
Middle Name:NIRANJAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W MAIN
Mailing Address - Street 2:#205
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6851
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:#205
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1549
Practice Address - Country:US
Practice Address - Phone:405-242-6494
Practice Address - Fax:405-242-6496
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100138360CMedicaid
G46164Medicare UPIN
OK100138360CMedicaid