Healthcare Provider Details

I. General information

NPI: 1285694083
Provider Name (Legal Business Name): MYRON ALAN SHOHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR SUITE 401
FAIRFAX VA
22033-1744
US

IV. Provider business mailing address

3700 JOSEPH SIEWICK DR SUITE 401
FAIRFAX VA
22033-1744
US

V. Phone/Fax

Practice location:
  • Phone: 703-281-1023
  • Fax: 703-620-2331
Mailing address:
  • Phone: 703-281-1023
  • Fax: 703-620-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberVA01C1029750
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: