Provider Demographics
NPI:1881670628
Name:SHAH, DHRUV J (MD)
Entity Type:Individual
Prefix:
First Name:DHRUV
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3610 W MARKET ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9301
Mailing Address - Country:US
Mailing Address - Phone:330-666-1400
Mailing Address - Fax:330-666-1414
Practice Address - Street 1:3610 W MARKET ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9301
Practice Address - Country:US
Practice Address - Phone:330-666-1400
Practice Address - Fax:330-666-0500
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35084026S2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2589220Medicaid
OHH21370Medicare UPIN
OH2589220Medicaid