1376529230 NPI number — DR. SHRIRAJ CHANDRAKANT SHAH M.D.

Table of content: DR. SHRIRAJ CHANDRAKANT SHAH M.D. (NPI 1376529230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376529230 NPI number — DR. SHRIRAJ CHANDRAKANT SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
SHRIRAJ
Provider Middle Name:
CHANDRAKANT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376529230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 W MONROE ST STE 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60603-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-733-9730
Provider Business Mailing Address Fax Number:
773-866-8014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 DIAMOND HILL RD STE 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-1554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-470-7116
Provider Business Practice Location Address Fax Number:
401-386-2462
Provider Enumeration Date:
12/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  192319 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01422013 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".