Healthcare Provider Details

I. General information

NPI: 1881890390
Provider Name (Legal Business Name): MEGHANA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S SEVENTH ST
MC BEE SC
29101-7101
US

IV. Provider business mailing address

645 S SEVENTH ST
MC BEE SC
29101-7101
US

V. Phone/Fax

Practice location:
  • Phone: 843-335-8291
  • Fax: 843-335-8731
Mailing address:
  • Phone: 843-335-8291
  • Fax: 843-335-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32547
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: