Healthcare Provider Details

I. General information

NPI: 1801739008
Provider Name (Legal Business Name): NISARG NIRMAL SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

1200 E BROAD ST BOX 980257
RICHMOND VA
23298-5025
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116042679
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: