Provider Demographics
NPI:1932129566
Name:SHAH, NIRISH S (MD)
Entity Type:Individual
Prefix:
First Name:NIRISH
Middle Name:S
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 1:202 DUKE OF GLOUCESTER SWST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1372
Mailing Address - Country:US
Mailing Address - Phone:540-510-3324
Mailing Address - Fax:540-345-4179
Practice Address - Street 1:100 RICE MINE RD
Practice Address - Street 2:
Practice Address - City:TUSACLOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-0000
Practice Address - Country:US
Practice Address - Phone:205-345-0010
Practice Address - Fax:205-752-1175
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255292207RG0100X
ALMD31211207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology