KETAN S. SHAH (NPI# 1083664023) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083664023 |
| Entity Type | Individual |
| Full Name | KETAN S. SHAH |
| Credential | MD |
| Practice Address |
3120 Governors Place Blvd Dayton OH 45409-1328 |
| Mailing Address |
6680 Poe Ave Suite 200 Dayton OH 45414-2854 |
| Practice Telephone | 9372931622 |
| Practice Fax Number | 9372456308 |
| Mailing Telephone | 9372808400 |
| Mailing Fax Number | 9372808373 |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-09-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
35061874-S | OH | Allopathic & Osteopathic Physicians |
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
35061874 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0824666 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3120 Governors Place Blvd, Dayton, OH 45409 | 9372931622 | 9372456308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689959900 | Ketan Mahendra Shah | Nurse Practitioner | 422 N Prospect St, Wheaton, IL 60187-5839 | 2011-10-18 |
| 1407137102 | Ketan H Shah | Pharmacist | 153 Wood Ave, Edison, NJ 08820-3504 | 2011-09-08 |
| 1841306693 | Ketan Shah | Otolaryngology | 1000 Eleven S, Ste 4f, Columbia, IL 62236-1080 | 2006-08-22 |
| 1609822360 | Ketan D. Shah | Podiatrist | 9234 Kennedy Blvd, North Bergen, NJ 07047-5312 | 2006-05-25 |
| 1144575788 | Ketan Yogesh Shah | Internal Medicine | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2012-07-19 |
| 1922390210 | Ketan R Shah | Nurse Anesthetist, Certified Registered | 3200 Tyre Neck Rd, Suite 101, Portsmouth, VA 23703-3329 | 2011-05-05 |
| 1790001535 | Ketan Vikrambhai Shah | Internal Medicine | 300 Highland Ave, Hanover, PA 17331-2297 | 2010-04-19 |
| 1629244652 | Ketan K Shah | Internal Medicine | 24221 Calle De La Louisa, Suite 300, Laguna Hills, CA 92653-7638 | 2008-04-30 |
| 1871507053 | Ketan Shah | Internal Medicine | 5500 Armstrong Rd, Battle Creek, MI 49015-1014 | 2006-07-27 |
| 1528098134 | Ketan Shah | Internal Medicine | 2211 E Franklin Blvd, Ste 100, Gastonia, NC 28054-4985 | 2006-07-03 |
| Street Address |
3120 GOVERNORS PLACE BLVD |
| City | DAYTON |
| State | OH |
| Zip Code | 45409-1328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508471376 | Oncology Hematology Care, Inc | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2020-09-09 |
| 1811440092 | Jackilyn Wilson | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2016-07-25 |
| 1972953032 | Kristina Marie Stallard | Registered Nurse | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2016-06-20 |
| 1407236680 | Johnna Beth Stamper | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2015-06-03 |
| 1437422243 | Kara Elizabeth Warren | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2012-02-10 |
| 1649598467 | Tracey Senften Hardin | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2010-05-05 |
| 1568694800 | Carol M Nikolai | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2009-08-20 |
| 1700015989 | Jennifer R Curtis | Nurse Practitioner | 3120 Governors Place Blvd, Dayton, OH 45409 | 2009-07-08 |
| 1023058427 | Mark D Romer | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487276457 | Matthew R Schaeffer | Surgery | 128 E Apple St., Wche 7th Floor, Dayton, OH 45409 | 2020-05-13 |
| 1699237545 | Elizabeth Joan Hudson | Student in an Organized Health Care Education/Training Program | 1 Wyoming Street Miami Valley Hospital Medical Educatio, Dayton, OH 45409 | 2019-04-01 |
| 1760941066 | Courtney Lyn Johnson | Surgery | 128 East Apple Street, Wche 7th Floor, Dayton, OH 45409 | 2019-03-16 |
| 1477057529 | Adam Joseph Langer | Student in an Organized Health Care Education/Training Program | 128 E. Apple St Suite 3800, Wright State University Dept of Ob/gyn, Dayton, OH 45409 | 2018-03-22 |
| 1659870939 | Timothy Wall | Student in an Organized Health Care Education/Training Program | 128 East Apple St., 2nd Floor, Dayton, OH 45409 | 2018-02-01 |
| 1124551411 | Adam Schmerge Deardorff | Student in an Organized Health Care Education/Training Program | 30 E Apple St Ste 6257, Dayton, OH 45409 | 2017-04-04 |
| 1205205358 | Kelby Snorf | Physician Assistant | 30 E Apple Street, Suite 3300, Dayton, OH 45409 | 2015-09-18 |
| 1689054223 | Jessica Ezinne Ugwu | Family Medicine | 30 E Apple St., Suite Nw 3300, Dayton, OH 45409 | 2015-06-08 |
| 1679983084 | Jude Anneryan Cohen | Registered Nurse | 1200 W. Dorothy Lane, Southdale Elementary School, Kettering, OH 45409 | 2014-05-07 |
| 1730517087 | Jesse Wayne Clark | Counselor | 65 Grady Ct, Dayton, OH 45409 | 2013-10-24 |
| Find all providers in zip 45409 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093765158 | Robert N Raju | Internal Medicine | 1191 Walnut Valley Ln, Dayton, OH 45458-9583 | 2006-05-11 |
| 1215927520 | Stuart A Merl | Internal Medicine | 10060 Simms Station Rd, Dayton, OH 45458-9656 | 2005-10-27 |
| 1508471376 | Oncology Hematology Care, Inc | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2020-09-09 |
| 1356622054 | Alliance Physician Inc | Internal Medicine | 405 W Grand Ave, 4th Floor, Dayton, OH 45405-4720 | 2011-09-08 |
| 1518156983 | Hematology & Oncology of Dayton, Inc. | Internal Medicine | 9000 N Main St Ste G-36, Dayton, OH 45415-1183 | 2007-10-22 |
| 1649281080 | Michael Alan Baumann | Internal Medicine | 4100 W 3rd St, Medicine (111w), Dayton, OH 45428-9000 | 2006-08-11 |
| 1023058427 | Mark D Romer | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2006-06-07 |
| 1407895535 | John J Haluschak | Internal Medicine | 9000 N Main St, Suite G36, Dayton, OH 45415-1180 | 2006-06-05 |
| 1700854239 | Florin D Andreca | Internal Medicine | 4881 Sugar Maple Dr, Dayton, OH 45433 | 2006-03-10 |
| 1649261470 | Medical Oncology-hematology Associates Inc. | Internal Medicine | 1 Elizabeth Pl, 10 Th Floor Suite 10b, Dayton, OH 45417-3445 | 2005-11-01 |
| Find all providers in DAYTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.