Basic Information
| Provider Information | |||||||||
| NPI: | 1558687111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | HAMZA | ||||||||
| MiddleName: | WALID | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2369 STAPLES MILL RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232302918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042858206 | ||||||||
| FaxNumber: | 0424403074 | ||||||||
| Practice Location | |||||||||
| Address1: | 7611 FOREST AVE STE 320 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232294946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042858206 | ||||||||
| FaxNumber: | 8042820616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2010 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0102206391 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1558687111 | 05 | VA | MEDICAID |