Provider Demographics
NPI:1811139470
Name:SHAH, ROHAN (MD)
Entity type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 WILLIAMS RD
Mailing Address - Street 2:STE 201
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4934
Mailing Address - Country:US
Mailing Address - Phone:423-756-1002
Mailing Address - Fax:423-756-1004
Practice Address - Street 1:1605 WILLIAMS RD
Practice Address - Street 2:STE 201
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4934
Practice Address - Country:US
Practice Address - Phone:423-756-1002
Practice Address - Fax:423-756-1004
Is Sole Proprietor?:No
Enumeration Date:2009-03-29
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD48412207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I187951Medicare PIN