Provider Demographics
NPI:1780632380
Name:SHAH, RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:RAHMAN
Middle Name:
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 1:2202 STATE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4582
Mailing Address - Country:US
Mailing Address - Phone:850-872-3939
Mailing Address - Fax:850-872-3938
Practice Address - Street 1:2202 STATE AVE STE 207
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4582
Practice Address - Country:US
Practice Address - Phone:850-872-3939
Practice Address - Fax:850-872-3938
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140805207R00000X, 207RC0000X, 207RI0011X
TN42984207RC0000X
MA230336208M00000X
VA0116023378390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043649OtherCONN PHYSICIAN LICENSE #
CT043649OtherCONN PHYSICIAN LICENSE #