Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | TP163 | KY |
NPI | 1245227735 |
---|---|
Provider Name | Ajit Shah |
First Address | Sewickley, PA 15143 |
Second Address | Lexington, KY 40536-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245227735 | NPI (01) | |
E64062 | (02) | |
TP163 | KENTUCKY MEDICAL LICENSE (01) | KY |