Provider Demographics
NPI:1881899557
Name:SHAH, RUTUL (MD)
Entity type:Individual
Prefix:
First Name:RUTUL
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 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:150 KINGSLEY LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4602
Practice Address - Country:US
Practice Address - Phone:757-484-5900
Practice Address - Fax:757-483-6671
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101253419207RS0012X
SC32541207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPO1162145OtherRAILROAD MEDICARE
SC325419Medicaid
SCGP4306OtherMEDICAID GROUP
SCGP3912OtherMEDICAID GROUP
SCAA58565019Medicare PIN
SCPO1162145OtherRAILROAD MEDICARE
SCAA58567153Medicare PIN
SC7153Medicare PIN