Provider Demographics
NPI:1396033437
Name:SHAH, RUCHIR ASHWINBHAI (MD)
Entity type:Individual
Prefix:
First Name:RUCHIR
Middle Name:ASHWINBHAI
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 1:975 E 3RD ST
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-9001
Mailing Address - Fax:423-778-4692
Practice Address - Street 1:1140 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:STAFFORD TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08050-2412
Practice Address - Country:US
Practice Address - Phone:732-897-7107
Practice Address - Fax:732-897-7227
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-008642084N0400X, 2084V0102X
FLME1430612084N0400X
LA3379932084N0400X
TN538882084N0400X, 2084V0102X
IN01082180A2084N0400X
NJ25MA116999002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME143061OtherSTATE LICENSE
LA337993OtherLA LICENSE