1205827078 NPI number — SARAH SHAHABUDDIN MD

Table of content: SARAH SHAHABUDDIN MD (NPI 1205827078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205827078 NPI number — SARAH SHAHABUDDIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAHABUDDIN
Provider First Name:
SARAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205827078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-0266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-285-0100
Provider Business Mailing Address Fax Number:
804-285-2458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 TEMPLE LAKE DR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-526-3450
Provider Business Practice Location Address Fax Number:
804-520-1809
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  0101231890 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 0101231890 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28581 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4800892 . This is a "UNITED HLTHCARE-MV" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1014285 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 154099 . This is a "ANTHEM-RICHMOND" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 154100 . This is a "ANTHEM-COLONIAL HEIGHTS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 154101 . This is a "ANTHEM-MECHANICSVILLE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184465 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010184703 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4800408 . This is a "UNITED HEALTHCARE-RICHMON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010184622 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010184746 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38371 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4800891 . This is a "UNITED HEALTHCARE-CH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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