Basic Information
| Provider Information | |||||||||
| NPI: | 1245261650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MEDICAL PKWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEDICAL PKWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101052810 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 7906232 | 05 | NC | MEDICAID | 06232 | 01 | NC | BC/BS | OTHER | 10015733 | 01 | VA | SENTARA OPTIMA | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 1245261650 | 05 | VA | MEDICAID | 187096 | 01 | VA | ANTHEM BC/BS | OTHER | 441762 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | -001 | 01 | VA | TRICARE/CHAMPUS | OTHER | 641762 | 01 | VA | UHC/MAMSI | OTHER | PAR | 01 | VA | AETNA | OTHER | 35167 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 010226562 | 05 | VA | MEDICAID | 269859 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER |