Provider Demographics
NPI:1972999696
Name:SHAH, ISHAN TARUN
Entity type:Individual
Prefix:
First Name:ISHAN
Middle Name:TARUN
Last Name:SHAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 FRANKLIN FARMS DR RM 130
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5100
Mailing Address - Country:US
Mailing Address - Phone:804-288-4827
Mailing Address - Fax:
Practice Address - Street 1:5875 BREMO RD STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-282-2685
Practice Address - Fax:804-282-0780
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272143207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine