Provider Demographics
NPI:1538802459
Name:SHAH, BHAVIN C (MD)
Entity type:Individual
Prefix:
First Name:BHAVIN
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3108
Mailing Address - Country:US
Mailing Address - Phone:973-897-9593
Mailing Address - Fax:272-243-2806
Practice Address - Street 1:1020 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3920
Practice Address - Country:US
Practice Address - Phone:580-223-5311
Practice Address - Fax:580-220-6429
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2025-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OK45402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program