Healthcare Provider Details

I. General information

NPI: 1528004447
Provider Name (Legal Business Name): GRACE L. SHIH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD SUITE 300
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

190 CAMPUS BLVD SUITE 300
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-1244
  • Fax: 540-667-3086
Mailing address:
  • Phone: 540-667-1244
  • Fax: 540-667-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101239367
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: