Provider Demographics
NPI:1982654042
Name:SHAH, HEMANG H (MD)
Entity Type:Individual
Prefix:MR
First Name:HEMANG
Middle Name:H
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2876 GUARDIAN LANE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7327
Mailing Address - Country:US
Mailing Address - Phone:757-463-5240
Mailing Address - Fax:757-463-6572
Practice Address - Street 1:3235 ACADEMY AVE
Practice Address - Street 2:STE 305
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3200
Practice Address - Country:US
Practice Address - Phone:757-686-9300
Practice Address - Fax:757-686-1514
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010538612084N0400X, 2084N0600X, 2278P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0629WOtherBLUE CROSS BLUE SHIELD
VA54527OtherSENTARA
VA007110090Medicaid
VA150572900OtherDEPT OF LABOR
VA7116314Medicaid
VA40724OtherVIRGINIA CHARTERED HEALTH
NC790651VMedicaid
VA339580OtherALLIANCE MAMSI
NC890629WMedicaid
VA0500125OtherUNITED HEALTHCARE
VA324792OtherANTHEM
VA339580OtherMPIPA OPTIMA CHOICE
VA007110090Medicaid
NC890629WMedicaid
VA54527OtherSENTARA
VA40724OtherVIRGINIA CHARTERED HEALTH
NC0629WOtherBLUE CROSS BLUE SHIELD