Healthcare Provider Details

I. General information

NPI: 1881670628
Provider Name (Legal Business Name): DHRUV J SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 W MARKET ST SUITE 108
FAIRLAWN OH
44333-9301
US

IV. Provider business mailing address

3610 W MARKET ST SUITE 108
FAIRLAWN OH
44333-9301
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-1400
  • Fax: 330-666-0500
Mailing address:
  • Phone: 330-666-1400
  • Fax: 330-666-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35084026S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: