Provider Demographics
NPI:1790075828
Name:SHAH, DHVANI (MD)
Entity Type:Individual
Prefix:
First Name:DHVANI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 PROSPERITY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1640
Mailing Address - Country:US
Mailing Address - Phone:240-485-5210
Mailing Address - Fax:240-485-5291
Practice Address - Street 1:2021 K ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-296-3449
Practice Address - Fax:202-296-0301
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD045061207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty