Healthcare Provider Details

I. General information

NPI: 1801893292
Provider Name (Legal Business Name): LOPA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
ELIZABETH NJ
07206-1511
US

IV. Provider business mailing address

3998 FAIR RDIGE DRIVE SUITE 300
FAIRFAX VA
22033
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-5200
  • Fax:
Mailing address:
  • Phone: 703-766-9725
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07357800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: