Provider Demographics
NPI:1467481754
Name:SHALF, JEROME M (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:SHALF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6372 MECHANICSVILLE TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-730-4690
Mailing Address - Fax:804-559-0333
Practice Address - Street 1:6372 MECHANICSVILLE TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4705
Practice Address - Country:US
Practice Address - Phone:804-730-4690
Practice Address - Fax:804-559-0333
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101026575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4063759OtherAETNA HMO
VA010167167Medicaid
VA254787OtherMAMSI
VA79148OtherSOUTHERN HEALTH SERVICES
VA79177OtherSOUTHERN HEALTH SERVICES
VA006702252Medicaid
VA1851619OtherCIGNA
VA237591OtherANTHEM BCBS OF VA
VA4063759OtherAETNA LIFE
VA45902OtherSENTARA
VA237591OtherANTHEM BCBS OF VA