Healthcare Provider Details

I. General information

NPI: 1073132957
Provider Name (Legal Business Name): PRAHAR SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL STE 100
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

4420 LAKE BOONE TRL STE 100
RALEIGH NC
27607-7505
US

V. Phone/Fax

Practice location:
  • Phone: 984-215-6950
  • Fax: 984-215-6951
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number2025-03006
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2025-03006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: