Provider Demographics
NPI:1750380333
Name:SHAH, GOPI Y (MD)
Entity type:Individual
Prefix:DR
First Name:GOPI
Middle Name:Y
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GOPI
Other - Middle Name:YOGESH
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:8 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8005
Practice Address - Country:US
Practice Address - Phone:803-256-6511
Practice Address - Fax:803-744-4731
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20171207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20171OtherSC LICENSE
SC201711Medicaid
SC201711Medicaid