MEDICARE: VINODBALA S 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	2084P0800X	Psychiatry Physician	35-04-5787-S	OH

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	:	1639195431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINODBALA S SHAH MD

Provider Business Mailing Address
First Line	:	201 HOSPITAL DR
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-2058
Country	:	US
Telephone Number	:	330-343-6631
Fax Number	:	330-343-8188

Provider Business Practice Location Address
First Line	:	201 HOSPITAL DR
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-2058
Country	:	US
Telephone Number	:	330-343-6631
Fax Number	:	330-343-8188

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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Directions to “ VINODBALA S SHAH MD” Practice Location

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