MEDICARE: VIJAYKUMAR SANKALCHAND 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	74865	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	:	1851381016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAYKUMAR SANKALCHAND SHAH MD

Provider Business Mailing Address
First Line	:	1932 NILES CORTLAND RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1055
Country	:	US
Telephone Number	:	330-856-7702
Fax Number	:	330-856-1096

Provider Business Practice Location Address
First Line	:	1932 NILES CORTLAND RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1055
Country	:	US
Telephone Number	:	330-856-7702
Fax Number	:	330-856-1096

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	05/21/2021

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