Provider Demographics
NPI:1346746963
Name:AZIZ, AHMAD SHAH I (DO)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:SHAH
Last Name:AZIZ
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6200
Mailing Address - Country:US
Mailing Address - Phone:540-741-9000
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6200
Practice Address - Country:US
Practice Address - Phone:540-741-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102206702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program