Provider Demographics
NPI:1851381016
Name:SHAH, VIJAYKUMAR SANKALCHAND (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:SANKALCHAND
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VIJAY
Other - Middle Name:SANKALCHAND
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1932 NILES CORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-856-7702
Mailing Address - Fax:330-856-1096
Practice Address - Street 1:1932 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-7702
Practice Address - Fax:330-856-1096
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH74865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080297Medicaid
G88979Medicare UPIN
OH2080297Medicaid