MEDICARE: MS. TANVIR B. 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	207L00000X	Anesthesiology Physician	01029328A	IN

General Provider Information

NPI Number	:	1295036572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANVIR B. SHAH MD

Provider Business Mailing Address
First Line	:	1210 LEXINGTON DRIVE
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-1949
Country	:	US
Telephone Number	:	812-948-2400
Fax Number	:	812-948-2400

Provider Business Practice Location Address
First Line	:	1210 LEXINGTON DRIVE
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-1949
Country	:	US
Telephone Number	:	812-948-2400
Fax Number	:	812-948-2400

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

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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