MEDICARE: JEROME M. SHALF M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101026575	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4063759	OTHER	VA	AETNA HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	254787	OTHER	VA	MAMSI
4	79148	OTHER	VA	SOUTHERN HEALTH SERVICES
5	79177	OTHER	VA	SOUTHERN HEALTH SERVICES
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1851619	OTHER	VA	CIGNA
8	237591	OTHER	VA	ANTHEM BCBS OF VA
9	4063759	OTHER	VA	AETNA LIFE
10	45902	OTHER	VA	SENTARA

NPI Number	:	1467481754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME M. SHALF M.D.

Provider Business Mailing Address
First Line	:	6372 MECHANICSVILLE TPKE
Second Line	:	SUITE 103
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-4705
Country	:	US
Telephone Number	:	804-730-4690
Fax Number	:	804-559-0333

Provider Business Practice Location Address
First Line	:	6372 MECHANICSVILLE TPKE
Second Line	:	SUITE 103
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-4705
Country	:	US
Telephone Number	:	804-730-4690
Fax Number	:	804-559-0333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	11/24/2009

6372 MECHANICSVILLE TPKE STE 111
MECHANICSVILLE, VA
23111-4705

Practice Phone: 804-477-4808
Practice Fax: 804-592-6971

6372 MECHANICSVILLE TPKE , SUITE 103
MECHANICSVILLE, VA
23111-4705