Provider Demographics
NPI:1457385965
Name:SHAH, NIRANJAN T (MD)
Entity Type:Individual
Prefix:
First Name:NIRANJAN
Middle Name:T
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 1:1000 MCKINLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6399
Mailing Address - Country:US
Mailing Address - Phone:740-383-7000
Mailing Address - Fax:
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7000
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043281207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0609096Medicaid
OH2105368Medicaid
OH0487035Medicare ID - Type UnspecifiedPALMETTO
OH0480375Medicare PIN
OH0609096Medicaid
H172021Medicare PIN
OH0487036Medicare ID - Type UnspecifiedPALMETTO