Provider Demographics
NPI:1417016346
Name:SHAH, NALINCHANDRA GOPALDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NALINCHANDRA
Middle Name:GOPALDAS
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NALIN
Other - Middle Name:GOPALDAS
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1516 BRIDGEWATER LN
Mailing Address - Street 2:PO BOX 3490
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-247-1122
Mailing Address - Fax:423-247-3856
Practice Address - Street 1:1516 BRIDGEWATER LN
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-247-1122
Practice Address - Fax:423-247-3856
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015776207K00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64663172Medicaid
B59718Medicare UPIN
KY64663172Medicaid