Basic Information
| Provider Information | |||||||||
| NPI: | 1124514039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | PALAK | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 32ND ST | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261052455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097217668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 MATTHEW ST | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457501635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403747700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2018 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 35.142809 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 208M00000X | 35.142809 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 30937 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 30937 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 35.142809 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.