Healthcare Provider Details

I. General information

NPI: 1750380333
Provider Name (Legal Business Name): GOPI Y SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GOPI YOGESH SHAH M. D.

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK DR SUITE 300
COLUMBIA SC
29203-8005
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-6511
  • Fax: 803-744-4731
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20171
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number20171
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: