1699790436 NPI number — ANISH P SHAH MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699790436 NPI number — ANISH P SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
ANISH
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699790436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14085 CROWN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22193-1458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-763-5224
Provider Business Mailing Address Fax Number:
703-763-5374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14085 CROWN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22193-1458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-763-5224
Provider Business Practice Location Address Fax Number:
703-763-5374
Provider Enumeration Date:
07/13/2006

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: 207RN0300X , with the licence number:  D0061027 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03010002 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 038049200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00376508 . This is a "RR MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00422892 . This is a "RRMCR DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 410276200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89511901 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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