MEDICARE: DR. TUSHAR C SHAH 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
1	207Q00000X	Family Medicine Physician	0101227828	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598871659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUSHAR C SHAH MD

Provider Business Mailing Address
First Line	:	4722 S LABURNUM AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-2712
Country	:	US
Telephone Number	:	804-604-2430
Fax Number	:	877-471-2996

Provider Business Practice Location Address
First Line	:	4722 S LABURNUM AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-2712
Country	:	US
Telephone Number	:	804-604-2430
Fax Number	:	877-471-2996

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	03/19/2026

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