Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0101251806 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101251806 | VA |
NPI | 1124224357 |
---|---|
Provider Name | Dr. Tushar A Shah |
First Address | Norfolk, VA 23507-1910 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 25/04/2020 |