Provider Demographics
NPI:1497963011
Name:SHAH, DISHANT G (MD)
Entity Type:Individual
Prefix:DR
First Name:DISHANT
Middle Name:G
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5627 JOSHUA TREE CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9341
Mailing Address - Country:US
Mailing Address - Phone:804-310-2337
Mailing Address - Fax:703-562-7971
Practice Address - Street 1:5627 JOSHUA TREE CIR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9341
Practice Address - Country:US
Practice Address - Phone:804-310-2337
Practice Address - Fax:703-562-7971
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1070812085R0202X
VA01160187782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology