Provider Demographics
NPI:1932135308
Name:MIRSHAHI, IRAJ (DO)
Entity Type:Individual
Prefix:
First Name:IRAJ
Middle Name:
Last Name:MIRSHAHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1926
Mailing Address - Country:US
Mailing Address - Phone:804-673-2814
Mailing Address - Fax:804-673-2873
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1926
Practice Address - Country:US
Practice Address - Phone:804-673-2814
Practice Address - Fax:804-673-2873
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110218853OtherRAILROAD MEDICARE
VA005859069Medicaid
VA178635OtherANTHEM BCBS OF VA
VA45878OtherSENTARA
VA131864OtherSOUTHERN HEALTH SERVICES
VA4515664OtherAETNA HMO
VA0022987OtherCIGNA
VA4515664OtherAETNA LIFE
VA279845OtherMAMSI
VA4515664OtherAETNA HMO
110007997Medicare ID - Type Unspecified