Provider Demographics
NPI:1386646420
Name:SHOR, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:SHOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 TELESTAR CT.
Mailing Address - Street 2:#300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:STE 550
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-437-5977
Practice Address - Fax:703-478-2475
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101043550207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060062626OtherRAILROAD MEDICARE VA #
DC031742500Medicaid
DC060034781OtherRAILROAD MEDICARE DC #
VA1386646420Medicaid
MD220681100Medicaid
VA060062626OtherRAILROAD MEDICARE VA #
DC031742500Medicaid
VAE19610Medicare UPIN
VA005868360Medicaid
DC031742500Medicaid
VA005868351Medicaid
VA6027776Medicaid