Basic Information
| Provider Information | |||||||||
| NPI: | 1609079151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUMADINE | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6350 CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235024107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572135683 | ||||||||
| FaxNumber: | 7572135762 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 GLENN MITCHELL DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575070425 | ||||||||
| FaxNumber: | 7575070426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD.204262 | LA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | ME103163 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 0101238679 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.