Provider Demographics
NPI:1932169968
Name:SHAH, GAURANG C (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURANG
Middle Name:C
Last Name:SHAH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:165 AMENDMENT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3036
Mailing Address - Country:US
Mailing Address - Phone:803-329-2700
Mailing Address - Fax:803-329-2788
Practice Address - Street 1:165 AMENDMENT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3036
Practice Address - Country:US
Practice Address - Phone:803-329-2700
Practice Address - Fax:803-329-2788
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-03-10
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Provider Licenses
StateLicense IDTaxonomies
SC22018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC27567Medicare UPIN