Healthcare Provider Details

I. General information

NPI: 1396825675
Provider Name (Legal Business Name): BHARAT J SHAH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
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: 330-572-0641
  • Fax: 330-572-0639
Mailing address:
  • Phone: 330-572-0641
  • Fax: 330-572-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35051270
License Number StateOH

VIII. Authorized Official

Name: DR. BHARAT J SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-572-0641