Provider Demographics
NPI:1669418786
Name:SHAH, ASIF (DPM)
Entity type:Individual
Prefix:
First Name:ASIF
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-934-9340
Mailing Address - Fax:804-934-9381
Practice Address - Street 1:3936 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-934-9340
Practice Address - Fax:804-934-9381
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300899213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA172530OtherANTHEM
VA2610193OtherCIGNA
VA010000475Medicaid
VA3367610OtherAETNA HMO
VA146328OtherANTHEM
VA3119449OtherMAMSI
VA32-0038270OtherUNITED HEALTH CARE
VAP00326083OtherMEDICARE RAILROAD
VA7547482OtherAETNA PPO
VA32-0038270-001OtherTRICARE
VA32-0038270OtherUNITED HEALTH CARE
VAP00326083OtherMEDICARE RAILROAD