Provider Demographics
NPI:1003304940
Name:SHAH, ROSHAN SURESHCHANDRA (MD)
Entity type:Individual
Prefix:
First Name:ROSHAN
Middle Name:SURESHCHANDRA
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 1:506 E CHEVES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2616
Mailing Address - Country:US
Mailing Address - Phone:843-390-8302
Mailing Address - Fax:843-390-8315
Practice Address - Street 1:3980 HIGHWAY 9 E STE 340
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8165
Practice Address - Country:US
Practice Address - Phone:843-390-8302
Practice Address - Fax:843-390-8315
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11088200207R00000X
390200000X
SC94653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program