Healthcare Provider Details

I. General information

NPI: 1326004896
Provider Name (Legal Business Name): TUSHAR NANDLAL SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 SUMMERFORD PL
CENTERVILLE OH
45458-4633
US

IV. Provider business mailing address

241 SUMMERFORD PL
CENTERVILLE OH
45458-4633
US

V. Phone/Fax

Practice location:
  • Phone: 937-371-1677
  • Fax:
Mailing address:
  • Phone: 937-371-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35-08-7069
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-08-7069
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number35-08-7069
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: