MEDICARE: KUNAL M SHAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	51270	MN
2	207K00000X	Allergy & Immunology Physician	103758	MN
3	207K00000X	Allergy & Immunology Physician	0101258836	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477714004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUNAL M SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	ROUND HILL
State	:	VA
Zip	:	20142-0307
Country	:	US
Telephone Number	:	703-665-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 W. LOUDOUN ST
Second Line	:	SUITE 200
City	:	ROUND HILL
State	:	VA
Zip	:	20141
Country	:	US
Telephone Number	:	703-665-0113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	02/21/2022

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