Provider Demographics
NPI:1457345951
Name:SHAHAB, SYED T (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:T
Last Name:SHAHAB
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 1:8501 ARLINGTON BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4625
Mailing Address - Country:US
Mailing Address - Phone:703-532-1700
Mailing Address - Fax:703-532-7803
Practice Address - Street 1:8501 ARLINGTON BLVD STE 330
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4625
Practice Address - Country:US
Practice Address - Phone:703-532-1700
Practice Address - Fax:703-532-7803
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2022-09-09
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
VA0101226888207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010003083Medicaid
VAJ444-0001OtherBCBS
VAJ444-0001OtherBCBS