Individual
ANISH P SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14085 CROWN CT, WOODBRIDGE, VA 22193-1458
(703) 763-5224
(703) 763-5374
Mailing address
14085 CROWN CT, WOODBRIDGE, VA 22193-1458
(703) 763-5224
(703) 763-5374
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
D0061027
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03010002
CARE FIRST BCBS
DC
05
—
038049200
—
DC
05
—
410276200
—
MD
01
—
89511901
CARE FIRST BCBS
MD
01
—
P00376508
RR MEDICARE
MD
01
—
P00422892
RRMCR DC
DC
Enumeration date
07/13/2006
Last updated
06/02/2011
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