Provider Demographics
NPI:1215262662
Name:SHAH, UMBAR (MD)
Entity type:Individual
Prefix:
First Name:UMBAR
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4922
Mailing Address - Country:US
Mailing Address - Phone:423-855-6868
Mailing Address - Fax:423-855-6896
Practice Address - Street 1:403 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4922
Practice Address - Country:US
Practice Address - Phone:423-855-6868
Practice Address - Fax:423-855-6896
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45048208000000X
IN01056325A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516119Medicaid
GA112376451AMedicaid
TN103I372440Medicare PIN