MEDICARE: DR. SHOAIB ALAM 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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	010244150	VA
2	207RP1001X	Pulmonary Disease Physician	0101244150	VA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101244150	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962451245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOAIB ALAM MD

Provider Business Mailing Address
First Line	:	9100 POND MILL CT
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-2858
Country	:	US
Telephone Number	:	717-608-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 POND MILL CT
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-2858
Country	:	US
Telephone Number	:	717-608-0040
Fax Number	:

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	02/19/2021

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