MEDICARE: VIPUL INDULAL SHAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	31225	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	AA30388552	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9690217	OTHER	SC	AETNA
2	064	OTHER	SC	BLUECHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000246527	OTHER	SC	UNISON
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	211192	OTHER	SC	MEDCOST

General Provider Information

NPI Number	:	1184839755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIPUL INDULAL SHAH MD

Provider Business Mailing Address
First Line	:	1203 E CHEVES ST
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2711
Country	:	US
Telephone Number	:	843-777-2564
Fax Number	:	843-537-2262

Provider Business Practice Location Address
First Line	:	1203 E CHEVES ST
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2711
Country	:	US
Telephone Number	:	843-777-5601
Fax Number	:	843-777-5135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	12/04/2023

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Directions to “ VIPUL INDULAL SHAH MD” Practice Location

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