Healthcare Provider Details

I. General information

NPI: 1245227735
Provider Name (Legal Business Name): AJIT SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # HX332E
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

1615 BLACKBURN HEIGHTS DR.
SEWICKLEY PA
15143
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5069
  • Fax: 859-257-4457
Mailing address:
  • Phone: 412-324-1078
  • Fax: 142-324-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD036456E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberTP163
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: