Provider Demographics
NPI:1912083361
Name:SHABAN SHOSHI MD INC
Entity Type:Organization
Organization Name:SHABAN SHOSHI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHABAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-266-8004
Mailing Address - Street 1:4100 JOHNSON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952
Mailing Address - Country:US
Mailing Address - Phone:740-266-8004
Mailing Address - Fax:740-266-8005
Practice Address - Street 1:4100 JOHNSON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952
Practice Address - Country:US
Practice Address - Phone:740-266-8004
Practice Address - Fax:740-266-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073795S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2054717Medicaid
OH2054717Medicaid