Healthcare Provider Details

I. General information

NPI: 1861454472
Provider Name (Legal Business Name): STEPHEN R SHAPIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD SUITE 500
FAIRFAX VA
22031-5218
US

IV. Provider business mailing address

8316 ARLINGTON BLVD SUITE 500
FAIRFAX VA
22031-5207
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-8410
  • Fax: 703-876-8417
Mailing address:
  • Phone: 703-876-8410
  • Fax: 703-876-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101014152
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberD15835
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: