MEDICARE: DHARMESH K 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	0101237991	VA

General Provider Information

NPI Number	:	1942264775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHARMESH K SHAH MD

Provider Business Mailing Address
First Line	:	667 KINGSBOROUGH SQ STE 101
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4999
Country	:	US
Telephone Number	:	757-842-4481
Fax Number	:	757-524-4396

Provider Business Practice Location Address
First Line	:	710 LIBERTY ST
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2637
Country	:	US
Telephone Number	:	757-543-6861
Fax Number	:	757-543-4082

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	06/20/2024

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