Provider Demographics
NPI:1194770461
Name:SHAH, SIDDHARTH RAJNIKANT (MD)
Entity type:Individual
Prefix:
First Name:SIDDHARTH
Middle Name:RAJNIKANT
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:RAJNIKANT
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2038 SPRINGDALE LN
Mailing Address - Street 2:
Mailing Address - City:TARRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35217-2028
Mailing Address - Country:US
Mailing Address - Phone:205-841-7665
Mailing Address - Fax:205-841-8366
Practice Address - Street 1:2038 SPRINGDALE LN
Practice Address - Street 2:
Practice Address - City:TARRANT
Practice Address - State:AL
Practice Address - Zip Code:35217-2028
Practice Address - Country:US
Practice Address - Phone:205-841-7665
Practice Address - Fax:205-841-8366
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051533146Medicaid
051533146Medicare PIN
ALI51578Medicare UPIN