Provider Demographics
NPI:1316963176
Name:SHAH-HOSSEINI, REZA (MD)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:SHAH-HOSSEINI
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 1:600 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1486
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-766-9575
Practice Address - Street 1:600 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1486
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-766-9575
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIE40950Medicare UPIN