Provider Demographics
NPI:1194876201
Name:SHAH, NARENDRA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:KUMAR
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 1:10035 PARK CEDAR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8910
Mailing Address - Country:US
Mailing Address - Phone:704-544-2524
Mailing Address - Fax:264-770-4544
Practice Address - Street 1:10035 PARK CEDAR DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8910
Practice Address - Country:US
Practice Address - Phone:704-544-2524
Practice Address - Fax:264-770-4544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-01029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976026Medicaid
F94746Medicare UPIN
2203630BMedicare ID - Type Unspecified