Provider Demographics
NPI:1750580502
Name:SHOJA, AMIR H (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:H
Last Name:SHOJA
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 1:46582 DRYSDALE TER
Mailing Address - Street 2:APT 103
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4318
Mailing Address - Country:US
Mailing Address - Phone:347-556-8386
Mailing Address - Fax:
Practice Address - Street 1:8302 OLD COURTHOUSE RD STE C
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3873
Practice Address - Country:US
Practice Address - Phone:703-462-8138
Practice Address - Fax:703-462-8139
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250470207R00000X
MN50146207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN031155000Medicaid
VA1750580502Medicaid
VAG02651Medicare PIN
MN810000173Medicare PIN