MEDICARE: SALEM PEDIATRICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992863450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM PEDIATRICS INC

Provider Business Mailing Address
First Line	:	7111 NORTH MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2565
Country	:	US
Telephone Number	:	937-277-6595
Fax Number	:	937-277-6998

Provider Business Practice Location Address
First Line	:	7111 NORTH MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2565
Country	:	US
Telephone Number	:	937-277-6595
Fax Number	:	937-277-6998

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAHESH M SHAH
Credential	:
Telephone Number	:	937-377-6595

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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Directions to “SALEM PEDIATRICS INC ” Practice Location

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