Individual
DR. LISA C SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4700 PUDDLEDOCK RD, SUITE 300, PRINCE GEORGE, VA 23875-1268
(804) 526-1111
(804) 526-2978
Mailing address
4700 PUDDLEDOCK RD, SUITE 300, PRINCE GEORGE, VA 23875-1268
(804) 526-1111
(804) 526-2978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102202032
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016465P04
MEDICARE PTAN
VA
Enumeration date
11/27/2007
Last updated
06/16/2015
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