Provider Demographics
NPI:1639140056
Name:SHAH, RASESH MEHENDRA (MD)
Entity Type:Individual
Prefix:
First Name:RASESH
Middle Name:MEHENDRA
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 1:725 VOLVO PKWY STE 210B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1621
Mailing Address - Country:US
Mailing Address - Phone:757-395-1600
Mailing Address - Fax:757-436-7834
Practice Address - Street 1:725 VOLVO PKWY STE 210B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1621
Practice Address - Country:US
Practice Address - Phone:757-395-1600
Practice Address - Fax:757-436-7834
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012304842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
770002816OtherMEDICARE RAILROAD
VA007302681Medicaid
770002816OtherMEDICARE RAILROAD
VA007302681Medicaid