Basic Information
| Provider Information | |||||||||
| NPI: | 1306466123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANDOAH ANESTHESIA & RESEARCH SERVICES , PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1912 SEPTEMBER CT | ||||||||
| Address2: | |||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 227013313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882761910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 541 SUNSET LN STE 201 | ||||||||
| Address2: | |||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 227013979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882761910 | ||||||||
| FaxNumber: | 5408298191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | ATHAR | ||||||||
| AuthorizedOfficialFirstName: | KHALID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8882761910 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1891995510 | 05 | VA | MEDICAID |