Provider Demographics
NPI:1891771630
Name:SHAH, BHARAT J (MD)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:J
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 1:63 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3601
Mailing Address - Country:US
Mailing Address - Phone:330-864-6331
Mailing Address - Fax:330-572-0639
Practice Address - Street 1:63 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3601
Practice Address - Country:US
Practice Address - Phone:330-864-6331
Practice Address - Fax:330-572-0639
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051270S2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0590212Medicaid
OH9337091Medicare ID - Type Unspecified
OH0590212Medicaid