Provider Demographics
NPI:1548391410
Name:SHAH, SYED MUBASHIR ALI (MD)
Entity Type:Individual
Prefix:
First Name:SYED MUBASHIR
Middle Name:ALI
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4521
Mailing Address - Country:US
Mailing Address - Phone:804-330-4901
Mailing Address - Fax:804-330-9141
Practice Address - Street 1:8262 ATLEE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1816
Practice Address - Country:US
Practice Address - Phone:804-559-6194
Practice Address - Fax:804-427-5352
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248098207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology