Provider Demographics
NPI:1972535300
Name:SHAH, ZAHEER A (MD)
Entity Type:Individual
Prefix:
First Name:ZAHEER
Middle Name:A
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 1:4665 DOUGLAS CIRCLE NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3673
Mailing Address - Country:US
Mailing Address - Phone:330-499-2209
Mailing Address - Fax:330-499-5884
Practice Address - Street 1:4665 DOUGLAS CIRCLE NW
Practice Address - Street 2:SUITE 103
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3673
Practice Address - Country:US
Practice Address - Phone:330-499-2209
Practice Address - Fax:330-499-5884
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042315208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0453898Medicaid
OH0453898Medicaid
0491894Medicare ID - Type Unspecified