Provider Demographics
NPI:1669661385
Name:M.C. & JYOTI SHAH INC.
Entity Type:Organization
Organization Name:M.C. & JYOTI SHAH INC.
Other - Org Name:M.C. SHAH, MD. INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHENDRAKUMAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-444-5911
Mailing Address - Street 1:509 S 3RD AVENUE
Mailing Address - Street 2:M.C. SHAH MD. INC.
Mailing Address - City:MIDDLEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:45760
Mailing Address - Country:US
Mailing Address - Phone:740-444-5911
Mailing Address - Fax:740-444-5913
Practice Address - Street 1:509 S. 3RD AVENUE
Practice Address - Street 2:M.C. SHAH. MD. INC.
Practice Address - City:MIDDLEPORT
Practice Address - State:OH
Practice Address - Zip Code:45760
Practice Address - Country:US
Practice Address - Phone:740-444-5911
Practice Address - Fax:740-444-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.050056207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547377Medicaid
WV0084205000Medicaid
WV0084205000Medicaid
WVA28198Medicare UPIN
OHSH4148742Medicare PIN
WV9349401Medicare PIN