Provider Demographics
NPI:1518960673
Name:SHAH, MINESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MINESH
Middle Name:
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 1:13908 US HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-3669
Mailing Address - Country:US
Mailing Address - Phone:434-432-0216
Mailing Address - Fax:434-432-3425
Practice Address - Street 1:13908 US HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3669
Practice Address - Country:US
Practice Address - Phone:434-432-0216
Practice Address - Fax:434-432-3425
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00454688OtherMEDICARE RAILROAD
NC89067MT/ 89011P8Medicaid
VA010071950Medicaid
338474OtherANTHEM BLUE CROSS
1673053OtherCIGNA
732430OtherSOUTHERN HEALTH
338474OtherANTHEM BLUE CROSS
P00454688OtherMEDICARE RAILROAD