Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 01078950A | IN |
NPI | 1588004600 |
---|---|
Provider Name | Ronak J Shah |
First Address | Charlotte, NC 28247-0408 |
Second Address | Charlotte, NC 28226-8198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 06/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01078950A | STATE LICENSE (01) | IN |
2019-02665 | NC LICENSE (01) | NC |