Provider Demographics
NPI:1659338416
Name:SHROFF, SAHIR G (MD)
Entity Type:Individual
Prefix:
First Name:SAHIR
Middle Name:G
Last Name:SHROFF
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 1:590 NANCY ST NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1334
Mailing Address - Country:US
Mailing Address - Phone:770-423-0395
Mailing Address - Fax:770-499-0352
Practice Address - Street 1:590 NANCY ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1334
Practice Address - Country:US
Practice Address - Phone:770-423-0395
Practice Address - Fax:770-499-0352
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055890208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7857762OtherAETNA PPO
GA52187671-002OtherBC/BS ID
GA1110018OtherAETNA HMO ID
GA550243697AMedicaid
GA7857762OtherAETNA PPO
GA550243697AMedicaid