Healthcare Provider Details

I. General information

NPI: 1306192794
Provider Name (Legal Business Name): ZAHEER A SHAH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 DOUGLAS CIR NW SUITE 103
CANTON OH
44718-3673
US

IV. Provider business mailing address

4665 DOUGLAS CIR NW SUITE 103
CANTON OH
44718-3673
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-2209
  • Fax: 330-499-5884
Mailing address:
  • Phone: 330-499-2209
  • Fax: 330-499-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35-04-2315
License Number StateOH

VIII. Authorized Official

Name: DR. ZAHEER A SHAH
Title or Position: OWNER
Credential: MD
Phone: 330-499-2209