Provider Demographics
NPI:1982793402
Name:SHAH, PUSHPA (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2701
Mailing Address - Country:US
Mailing Address - Phone:513-221-4949
Mailing Address - Fax:513-241-4191
Practice Address - Street 1:2415 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2701
Practice Address - Country:US
Practice Address - Phone:513-241-4949
Practice Address - Fax:513-241-4191
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063125S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0896311Medicaid
OH000000374019OtherANTHEM BCBS
OHSH4125175Medicare ID - Type Unspecified
OH000000374019OtherANTHEM BCBS