Healthcare Provider Details

I. General information

NPI: 1962451245
Provider Name (Legal Business Name): SHOAIB ALAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 POND MILL CT
GLEN ALLEN VA
23060-2858
US

IV. Provider business mailing address

9100 POND MILL CT
GLEN ALLEN VA
23060-2858
US

V. Phone/Fax

Practice location:
  • Phone: 717-608-0040
  • Fax:
Mailing address:
  • Phone: 717-608-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101244150
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101244150
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number010244150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: