Provider Demographics
NPI:1497943344
Name:SHAH, SAUMIL R (MD)
Entity Type:Individual
Prefix:
First Name:SAUMIL
Middle Name:R
Last Name:SHAH
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 1:1001 BOULDERS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5513
Mailing Address - Country:US
Mailing Address - Phone:804-410-9749
Mailing Address - Fax:804-272-3409
Practice Address - Street 1:1001 BOULDERS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-410-9749
Practice Address - Fax:804-272-3409
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251688207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084711AMedicaid
MA000705003Medicare PIN
MA110084711AMedicaid