Healthcare Provider Details

I. General information

NPI: 1891771630
Provider Name (Legal Business Name): BHARAT J SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BAKER BLVD
FAIRLAWN OH
44333-3601
US

IV. Provider business mailing address

63 BAKER BLVD
FAIRLAWN OH
44333-3601
US

V. Phone/Fax

Practice location:
  • Phone: 330-864-6331
  • Fax: 330-572-0639
Mailing address:
  • Phone: 330-864-6331
  • Fax: 330-572-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35051270S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: