Provider Demographics
NPI:1477714004
Name:SHAH, KUNAL M (MD)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20142-0307
Mailing Address - Country:US
Mailing Address - Phone:703-665-0113
Mailing Address - Fax:
Practice Address - Street 1:2 W. LOUDOUN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND HILL
Practice Address - State:VA
Practice Address - Zip Code:20141
Practice Address - Country:US
Practice Address - Phone:703-665-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51270207K00000X
MN103758207K00000X
VA0101258836207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN030000303Medicare PIN