Provider Demographics
NPI:1700317369
Name:AKBAR, SHALLA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SHALLA
Middle Name:
Last Name:AKBAR
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:SHALLA
Other - Middle Name:
Other - Last Name:AKBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2064
Mailing Address - Fax:614-292-7072
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-5905
Practice Address - Fax:614-293-4715
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35143779207ZP0104X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000788Medicaid