Basic Information
| Provider Information | |||||||||
| NPI: | 1043274772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | CHIRAG | ||||||||
| MiddleName: | ASHVIN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453430229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138740486 | ||||||||
| FaxNumber: | 5132808868 | ||||||||
| Practice Location | |||||||||
| Address1: | 6730 ROOSEVELT AVE STE 303 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450050017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138740486 | ||||||||
| FaxNumber: | 5132808868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35-078612 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 35-078612 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200987690 | 05 | IN | MEDICAID | 7100188160 | 05 | KY | MEDICAID | 0154658 | 05 | OH | MEDICAID | P00388640 | 01 | RR MEDICARE | OTHER | P1009946 | 01 | OH | RR MEDICARE | OTHER |