Provider Demographics
NPI:1942264775
Name:SHAH, DHARMESH K (MD)
Entity Type:Individual
Prefix:
First Name:DHARMESH
Middle Name:K
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 1:710 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-2637
Mailing Address - Country:US
Mailing Address - Phone:757-543-6861
Mailing Address - Fax:757-543-4082
Practice Address - Street 1:710 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2637
Practice Address - Country:US
Practice Address - Phone:757-543-6861
Practice Address - Fax:757-543-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014930T06Medicare PIN
I35600Medicare UPIN