Provider Demographics
NPI:1093828451
Name:SHAH, MUKESH HARILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:HARILAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 MEDICAL DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1765
Mailing Address - Country:US
Mailing Address - Phone:757-788-0092
Mailing Address - Fax:757-788-0969
Practice Address - Street 1:200 MEDICAL DR
Practice Address - Street 2:SUITE A & B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1763
Practice Address - Country:US
Practice Address - Phone:757-788-0200
Practice Address - Fax:757-788-0950
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010367272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659424448Medicaid
VA260020529OtherMEDICARE RR
VA1659424448Medicaid
VA260003045Medicare PIN