Provider Demographics
NPI:1730287020
Name:SHAH, ASHISH C (MD)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:C
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 1:405 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5045
Mailing Address - Country:US
Mailing Address - Phone:336-627-4896
Mailing Address - Fax:336-627-0139
Practice Address - Street 1:405 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5045
Practice Address - Country:US
Practice Address - Phone:336-627-4896
Practice Address - Fax:336-627-0139
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1145AOtherBCBS NC INDIVIDUAL #
NC891145AMedicaid
NCG75937Medicare UPIN
NC2253956Medicare ID - Type UnspecifiedMEDICARE ID #