Provider Demographics
NPI: | 1336313717 |
---|---|
Name: | SHAH, PALAK (MD, MS) |
Entity type: | Individual |
Prefix: | DR |
First Name: | PALAK |
Middle Name: | |
Last Name: | SHAH |
Suffix: | |
Gender: | M |
Credentials: | MD, MS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3300 GALLOWS ROAD |
Mailing Address - Street 2: | TRANSPLANT PROGRAM - IHVI |
Mailing Address - City: | FALLS CHURCH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22042 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-776-7075 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3300 GALLOWS RD |
Practice Address - Street 2: | |
Practice Address - City: | FALLS CHURCH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22042-3307 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-776-7075 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-04-17 |
Last Update Date: | 2023-11-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101242687 | 207RA0001X |
MI | 4301100466 | 207R00000X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Yes | 207RA0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Advanced Heart Failure and Transplant Cardiology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |