Provider Demographics
NPI:1891725479
Name:SHAH, VIREN JASHVANTLAL (MD)
Entity Type:Individual
Prefix:
First Name:VIREN
Middle Name:JASHVANTLAL
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:111 HWY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2080
Practice Address - Country:US
Practice Address - Phone:615-446-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911938Medicaid
TN4154439OtherBLUECROSS
AL009936542Medicaid
TN3325175Medicaid
TNP00293441OtherRAILROAD MEDICARE
GA806918263BMedicaid
TN4118465OtherBLUECROSS
GA806918263CMedicaid
TN3325174Medicaid
TN4118464OtherBCBS OF TENNESSEE
TN3325174Medicare PIN
TN3325175Medicare PIN
GA806918263CMedicaid