Provider Demographics
NPI:1760449748
Name:SHAHAB-UDDIN, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:SHAHAB-UDDIN
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 1:16011 KAIROS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5207
Mailing Address - Country:US
Mailing Address - Phone:804-520-2600
Mailing Address - Fax:
Practice Address - Street 1:16011 KAIROS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5207
Practice Address - Country:US
Practice Address - Phone:804-520-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA56041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA271717OtherANTHEM HEALTH KEEPERS PL
VA006761453Medicaid
VA006761453Medicaid