Healthcare Provider Details

I. General information

NPI: 1730143538
Provider Name (Legal Business Name): GAURANG NAGINLAL SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST STE 2900
ANDERSON SC
29621-1722
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-5849
  • Fax: 864-512-7575
Mailing address:
  • Phone: 864-512-5849
  • Fax: 864-512-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME 38507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: