Basic Information
| Provider Information | |||||||||
| NPI: | 1831327097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SURAJ | ||||||||
| MiddleName: | PRAVIN | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562653880 | ||||||||
| FaxNumber: | 2562653886 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275408906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197847093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 08/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 31873 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2018-00078 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2018-00078 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.