Healthcare Provider Details

I. General information

NPI: 1063743722
Provider Name (Legal Business Name): DHAVAL RAMESHCHANDRA SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 3400
NEWARK DE
19713-2055
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD SUITE 3400
NEWARK DE
19713-2055
US

V. Phone/Fax

Practice location:
  • Phone: 609-702-1900
  • Fax: 302-366-1700
Mailing address:
  • Phone: 609-702-1900
  • Fax: 302-366-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberP3446
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC1-0011583
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: