Healthcare Provider Details

I. General information

NPI: 1396886362
Provider Name (Legal Business Name): KEYUR BHARAT SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 03/02/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL STREET
RICHMOND VA
23298-0510
US

IV. Provider business mailing address

PO BOX 91734 INTERNAL MEDICINE
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9690
  • Fax: 804-828-5566
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number0101245306
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101245306
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: