Provider Demographics
NPI:1598871659
Name:SHAH, TUSHAR C (MD)
Entity Type:Individual
Prefix:DR
First Name:TUSHAR
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 RIVERS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836
Mailing Address - Country:US
Mailing Address - Phone:804-530-0707
Mailing Address - Fax:804-530-0074
Practice Address - Street 1:13121 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836
Practice Address - Country:US
Practice Address - Phone:804-530-0707
Practice Address - Fax:804-530-0074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5640563Medicaid
080007924Medicare PIN
VAH10891Medicare UPIN
VA080007924Medicare ID - Type Unspecified