Provider Demographics
NPI:1922172410
Name:SHAH, MAHENDRAKUMAR C (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHENDRAKUMAR
Middle Name:C
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 1:509 S. 3RD AVENUE
Mailing Address - Street 2:M.C. SHAH, MD INC
Mailing Address - City:MIDDLEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:45760
Mailing Address - Country:US
Mailing Address - Phone:740-444-5911
Mailing Address - Fax:740-444-5913
Practice Address - Street 1:509 S. 3RD AVENUE
Practice Address - Street 2:M.C. SHAH MD INC
Practice Address - City:MIDDLEPORT
Practice Address - State:OH
Practice Address - Zip Code:45760
Practice Address - Country:US
Practice Address - Phone:740-444-5911
Practice Address - Fax:740-444-5913
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13785207R00000X
OH35.050056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547377Medicaid
WV0084205000Medicaid
WV0084205000Medicaid
OH9349402Medicare PIN
WV4148741Medicare PIN
WVA28198Medicare UPIN
OH0547377Medicaid