MEDICARE: VATSALA NIRANJAN 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	207R00000X	Internal Medicine Physician	18903	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376535328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VATSALA NIRANJAN SHAH MD

Provider Business Mailing Address
First Line	:	1225 W MAIN
Second Line	:	#205
City	:	NORMAN
State	:	OK
Zip	:	73069-6851
Country	:	US
Telephone Number	:	405-292-5500
Fax Number	:	405-292-5505

Provider Business Practice Location Address
First Line	:	4301 NW 63RD ST
Second Line	:	#205
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1549
Country	:	US
Telephone Number	:	405-242-6494
Fax Number	:	405-242-6496

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	01/07/2016

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