Healthcare Provider Details

I. General information

NPI: 1851406227
Provider Name (Legal Business Name): ATUL P SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELDAY AVE
WINTERSVILLE OH
43953-3779
US

IV. Provider business mailing address

100 WELDAY AVE
WINTERSVILLE OH
43953-3779
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-5770
  • Fax: 740-264-5780
Mailing address:
  • Phone: 740-264-5770
  • Fax: 740-264-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35067415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: