Provider Demographics
NPI:1194123117
Name:SHAH, BHARAT (OTR)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 LANDIS WAY N
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-6408
Mailing Address - Country:US
Mailing Address - Phone:302-439-4800
Mailing Address - Fax:
Practice Address - Street 1:166 LANDIS WAY N
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-6408
Practice Address - Country:US
Practice Address - Phone:302-439-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0000066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist