Basic Information
| Provider Information | |||||||||
| NPI: | 1326490699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | ISHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 BREWSTER ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017292258 | ||||||||
| FaxNumber: | 4017293343 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016812858 | ||||||||
| FaxNumber: | 4019216943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2016 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | MD17764 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207R00000X | LP03797 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.