=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700998648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PARESH SHAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 RICHLAND MEDICAL PARK DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-6849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-434-6301
-----------------------------------------------------
Fax | 803-936-0003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11400
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-434-6301
-----------------------------------------------------
Fax | 803-936-0003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 8152
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------