Provider Demographics
NPI:1134157027
Name:SHAH, KIRITKUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KIRITKUMAR
Middle Name:
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 1:100 CONSTITUTION DR
Mailing Address - Street 2:STE. 217
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6799
Mailing Address - Country:US
Mailing Address - Phone:757-499-7442
Mailing Address - Fax:757-490-3638
Practice Address - Street 1:100 CONSTITUTION DR
Practice Address - Street 2:STE. 217
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6799
Practice Address - Country:US
Practice Address - Phone:757-499-7442
Practice Address - Fax:757-490-3638
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA18852OtherOPTIMA, FAMILY CARE,FAMIS
VA271865OtherMAMSI,OPTI CHOICE,MDIPA
VA5417787860282EOtherCIGNA
VA452095OtherANTHM BCBS,HK, HK,FAMIS
VA6730591Medicaid
VA67547259OtherTRICARE,HUMANA,CHAMPVA
VA271865OtherMAMSI,OPTI CHOICE,MDIPA