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General NPI Number Information
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NPI Number | 1548391410
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Entity Type | Individual
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Provider Name | SYED MUBASHIR ALI SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 8262 ATLEE RD SUITE 202
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-1816
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Country | US
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Telephone | 804-559-6194
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Fax | 804-427-5352
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Provider Business Mailing Address
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Address Line | 107 WADSWORTH DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-4521
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Country | US
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Telephone | 804-330-4901
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Fax | 804-330-9141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101248098
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License Number State | VA
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