MEDICARE: AMIT G 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	20170	SC

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	:	1740288323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIT G SHAH MD

Provider Business Mailing Address
First Line	:	1040 EDGEWATER CORP PKWY STE 101
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-4514
Country	:	US
Telephone Number	:	803-548-7007
Fax Number	:	803-802-2015

Provider Business Practice Location Address
First Line	:	1040 EDGEWATER CORP PKWY STE 101
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-4514
Country	:	US
Telephone Number	:	803-548-7007
Fax Number	:	803-802-2015

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/20/2016

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Directions to “ AMIT G SHAH MD” Practice Location

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