Provider Demographics
NPI:1316940091
Name:SHAH, ARUNA (MD)
Entity type:Individual
Prefix:DR
First Name:ARUNA
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:2033 MEADOWVIEW LN
Practice Address - Street 2:STE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-857-2260
Practice Address - Fax:423-857-2261
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 39090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3339590Medicaid
VA010124077Medicaid
TN0281780003Medicare PIN
TN3339590Medicare ID - Type Unspecified
I19174Medicare UPIN
TN3339590Medicaid
VA010124077Medicaid
TNCN8860Medicare PIN
TNP00183234Medicare PIN