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NPI Code Detail

MEDICARE: GERTRUDE K SHAHADY MD

MEDICARE: GERTRUDE K SHAHADY MD
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101229867VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3080186503OTHERVAMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2460635OTHERANTHEM
40907130004OTHERVADME RUSTBURG
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487639878
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERTRUDE K SHAHADY MD
Provider Business Mailing Address
First Line : PO BOX 69
Second Line :
City : RUSTBURG
State : VA
Zip : 24588-0069
Country : US
Telephone Number : 434-332-7367
Fax Number : 434-332-1757
Provider Business Practice Location Address
First Line : 925 VILLAGE HWY
Second Line :
City : RUSTBURG
State : VA
Zip : 24588-4591
Country : US
Telephone Number : 434-332-7367
Fax Number : 434-332-1757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 08/13/2013

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Directions to “ GERTRUDE K SHAHADY MD” Practice Location

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