Provider Demographics
NPI:1912053695
Name:SHAH, ALAP PRAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAP
Middle Name:PRAVIN
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:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:1001 BOULDERS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5513
Practice Address - Country:US
Practice Address - Phone:804-410-9749
Practice Address - Fax:804-272-3498
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36740207RC0001X
MO2019042370207RC0001X
VA0101273788207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002225OtherMEDICARE PTAN
KS201084310AMedicaid