Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 35061874 | OH |
N | 207RH0003X | Hematology & Oncology | 35061874-S | OH |
N | 207RX0202X | Medical Oncology | 35.061874 | OH |
NPI | 1083664023 |
---|---|
Provider Name | Ketan S. Shah |
First Address | Dayton, OH 45414-2855 |
Second Address | Dayton, OH 45409-1328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 07/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0824666 | (05) | OH |