Provider Demographics
NPI:1174563282
Name:SHAH, ANJANA HEMANT (MD)
Entity type:Individual
Prefix:
First Name:ANJANA
Middle Name:HEMANT
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ANJANA
Other - Middle Name:AWRALAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:722 N. FAIRFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434
Mailing Address - Country:US
Mailing Address - Phone:937-208-7000
Mailing Address - Fax:937-208-7010
Practice Address - Street 1:722 N. FAIRFIELD RD.
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-208-7000
Practice Address - Fax:937-208-7010
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-5984-S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0952796Medicaid
SH0754721Medicare ID - Type Unspecified
OH0952796Medicaid
OH0754722Medicare PIN