Healthcare Provider Details

I. General information

NPI: 1497943344
Provider Name (Legal Business Name): SAUMIL R SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BOULDERS PKWY STE 110
NORTH CHESTERFIELD VA
23225
US

IV. Provider business mailing address

1001 BOULDERS PKWY STE 110
NORTH CHESTERFIELD VA
23225-5513
US

V. Phone/Fax

Practice location:
  • Phone: 804-410-9749
  • Fax: 804-272-3409
Mailing address:
  • Phone: 804-410-9749
  • Fax: 804-272-3409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0101251688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: