1386646420 NPI number — ROBERT A. SHOR M.D.

Table of content: ROBERT A. SHOR M.D. (NPI 1386646420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386646420 NPI number — ROBERT A. SHOR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOR
Provider First Name:
ROBERT
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1386646420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 TELESTAR CT.
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-1263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-591-1688
Provider Business Mailing Address Fax Number:
703-591-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
STE 550
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-437-5977
Provider Business Practice Location Address Fax Number:
703-478-2475
Provider Enumeration Date:
06/01/2005

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: 207RC0000X , with the licence number:  0101043550 , 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: 060062626 . This is a "RAILROAD MEDICARE VA #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 031742500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060034781 . This is a "RAILROAD MEDICARE DC #" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1386646420 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220681100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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