Provider Demographics
NPI:1942419692
Name:SHAH, RAKESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:KUMAR
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 1:269 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9337
Mailing Address - Country:US
Mailing Address - Phone:804-861-0700
Mailing Address - Fax:804-863-4626
Practice Address - Street 1:207 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2503
Practice Address - Country:US
Practice Address - Phone:804-541-0918
Practice Address - Fax:804-541-7924
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012482232084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry