Provider Demographics
NPI:1487666335
Name:SHAH, GAURANG (DO)
Entity Type:Individual
Prefix:
First Name:GAURANG
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 ANGEL DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9533
Mailing Address - Country:US
Mailing Address - Phone:513-734-6979
Mailing Address - Fax:513-734-6210
Practice Address - Street 1:3088 ANGEL DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9533
Practice Address - Country:US
Practice Address - Phone:513-734-6979
Practice Address - Fax:513-734-6210
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2694795Medicaid
OH2694795Medicaid
OH4195102Medicare PIN