Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 31225 | SC |
NPI | 1184839755 |
---|---|
Provider Name | Vipul I Shah |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 27/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000246527 | UNISON (01) | SC |
064 | BLUECHOICE (01) | SC |
211192 | MEDCOST (01) | SC |
312254 | (05) | SC |
5910037 | (05) | NC |
9690217 | AETNA (01) | SC |
AA30388552 | MEDICARE PTAN (01) | SC |