Provider Demographics
NPI:1790532141
Name:SHAH, RAJIV NILESCHANDRA (MD)
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:NILESCHANDRA
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 1:9946 NICOLE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6259
Mailing Address - Country:US
Mailing Address - Phone:224-247-8830
Mailing Address - Fax:
Practice Address - Street 1:SUMMERVILLE MEDICAL CENTER
Practice Address - Street 2:295 MIDLAND PKWY
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485
Practice Address - Country:US
Practice Address - Phone:843-970-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program