Provider Demographics
NPI:1548264179
Name:SHAH, BHARAT C (MD)
Entity type:Individual
Prefix:DR
First Name:BHARAT
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 LEAVITT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2139
Mailing Address - Country:US
Mailing Address - Phone:440-989-2066
Mailing Address - Fax:440-989-1153
Practice Address - Street 1:4804 LEAVITT RD
Practice Address - Street 2:SUITE A
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2139
Practice Address - Country:US
Practice Address - Phone:440-989-2066
Practice Address - Fax:440-989-1153
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-8483-S174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201446300OtherFEDERAL WORKERS COMPENSAT
OHBA-8214437OtherMULTIPLAN
OH0781186Medicaid
OH353056OtherWELLCARE
OH720000157OtherRR MEDICARE
OHMEDICAL MUTUAL OF OHOtherINDIVIDUAL PROVIDER NUMBE
OH341961205027OtherCARESOURCE
OH000000220928OtherANTHEM
OH7412481OtherAETNA
OH0722134004OtherCIGNA
OH106628OtherKAISER PERMANENTE
OH353056OtherWELLCARE
OHE76627Medicare UPIN