MEDICARE: DHRUV J SHAH M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	35084026S	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	:	1881670628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHRUV J SHAH M.D.

Provider Business Mailing Address
First Line	:	3610 W MARKET ST
Second Line	:	SUITE 108
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-9301
Country	:	US
Telephone Number	:	330-666-1400
Fax Number	:	330-666-1414

Provider Business Practice Location Address
First Line	:	3610 W MARKET ST
Second Line	:	SUITE 108
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-9301
Country	:	US
Telephone Number	:	330-666-1400
Fax Number	:	330-666-0500

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	04/26/2013

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