Individual
RUTUL SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(757) 484-5900
(757) 483-6671
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
32541
SC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
0101253419
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325419
—
SC
01
—
GP3912
MEDICAID GROUP
SC
01
—
GP4306
MEDICAID GROUP
SC
01
—
PO1162145
RAILROAD MEDICARE
SC
Enumeration date
06/20/2007
Last updated
09/17/2024
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