Provider Demographics
NPI:1740455591
Name:SHADCHEHR, ALI
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:SHADCHEHR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:SHADCHEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5170 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-6112
Mailing Address - Country:US
Mailing Address - Phone:614-457-5306
Mailing Address - Fax:614-457-5306
Practice Address - Street 1:5170 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-6112
Practice Address - Country:US
Practice Address - Phone:614-457-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061167207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology