Provider Demographics
NPI:1407908445
Name:MAHENDRA D.SHAH,M.D.& ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:MAHENDRA D.SHAH,M.D.& ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:DEVSHIBHAI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:180-476-1016
Mailing Address - Street 1:4207 WHITFORD CT
Mailing Address - Street 2:# 1703
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4138
Mailing Address - Country:US
Mailing Address - Phone:180-476-1016
Mailing Address - Fax:180-476-1016
Practice Address - Street 1:4207 WHITFORD CT
Practice Address - Street 2:# 1703
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4138
Practice Address - Country:US
Practice Address - Phone:180-476-1016
Practice Address - Fax:180-476-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010459062080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty