Provider Demographics
NPI:1730143538
Name:SHAH, GAURANG NAGINLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURANG
Middle Name:NAGINLAL
Last Name:SHAH
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:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5849
Mailing Address - Fax:864-512-7575
Practice Address - Street 1:2000 E GREENVILLE ST STE 2900
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1722
Practice Address - Country:US
Practice Address - Phone:864-512-5849
Practice Address - Fax:864-512-7575
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 38507207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066207100Medicaid
FL066207100Medicaid
FL15649AMedicare ID - Type Unspecified