Basic Information
| Provider Information | |||||||||
| NPI: | 1932129566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | NIRISH | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 DUKE OF GLOUCESTER SWST | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405103324 | ||||||||
| FaxNumber: | 5403454179 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 RICE MINE RD | ||||||||
| Address2: | |||||||||
| City: | TUSACLOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354060000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450010 | ||||||||
| FaxNumber: | 2057521175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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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 | 207RG0100X | 0101255292 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.