Healthcare Provider Details

I. General information

NPI: 1467420133
Provider Name (Legal Business Name): NIRAV P SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2742
US

IV. Provider business mailing address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2742
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-7800
  • Fax: 704-414-7512
Mailing address:
  • Phone: 704-334-7800
  • Fax: 704-414-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number158583
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number158583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: