Individual
SHAHAB M EHTESHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 TRENT ST NE, NORTON, VA 24273-1533
(276) 679-4200
(276) 679-4230
Mailing address
PO BOX 386, WISE, VA 24293
(276) 679-4200
(276) 679-4230
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101225223
VA
207R00000X
Internal Medicine Physician
32845
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010287669
—
VA
Enumeration date
04/11/2006
Last updated
06/21/2023
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