Healthcare Provider Details

I. General information

NPI: 1861482572
Provider Name (Legal Business Name): ROBERT SHIH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3811 FAIRFAX DR STE 1000
ARLINGTON VA
22203-1782
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD210002558
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01058674A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: