Individual
PAVANI THOTAKURA SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1210 W FARIS RD, GREENVILLE, SC 29605-4444
(864) 522-1800
(864) 522-1806
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.060992
IL
2085R0202X
Diagnostic Radiology Physician
2017-01250
NC
2085R0202X
Diagnostic Radiology Physician
Primary
82380
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10118Q
—
SC
Enumeration date
07/30/2012
Last updated
12/07/2022
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