Provider Demographics
NPI:1225296502
Name:WARAICH, SHAHID A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:A
Last Name:WARAICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25445 FRITZ CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3063
Mailing Address - Country:US
Mailing Address - Phone:703-542-6224
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:703-522-8840
Practice Address - Fax:703-348-3916
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00735258OtherMEDICARE RR
VAP00735258OtherMEDICARE RR
VA020533I24Medicare PIN