Provider Demographics
NPI:1932355955
Name:SHAFTEL, NOAH DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:DANIEL
Last Name:SHAFTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2309
Mailing Address - Country:US
Mailing Address - Phone:513-221-5500
Mailing Address - Fax:513-221-1962
Practice Address - Street 1:11140 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-221-5500
Practice Address - Fax:513-221-1962
Is Sole Proprietor?:No
Enumeration Date:2008-08-10
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1212992086S0105X
IL125.053208207X00000X
OH35121299207XS0106X
KY46231207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100262100Medicaid
OH0090859Medicaid
KYK129520Medicare PIN
OHH247180Medicare PIN