Individual
DR. SANGEETHA SHAN-BALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3300 GALLOWS RD DEPT OF, FALLS CHURCH, VA 22042
(703) 776-3582
Mailing address
3300 GALLOWS RD DEPT OF, FALLS CHURCH, VA 22042-3307
(703) 776-3582
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101241278
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
0101241278
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
010124278
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-53885
EVERCARE
—
01
—
1356471676
ANTHEM BCBS
—
01
—
5374-0021
BCBS OF DC
—
01
—
541908787001
TRICARE
—
Enumeration date
03/06/2007
Last updated
05/16/2018
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