| Medical Practice, Ltd. | |
|
710 Liberty St Chesapeake VA 23324-2637 | |
| (757) 543-6861 | |
| (757) 543-4082 |
| Full Name | Medical Practice, Ltd. |
|---|---|
| Speciality | Internal Medicine |
| Location | 710 Liberty St, Chesapeake, Virginia |
| Authorized Official Name and Position | Dharmesh K Shah (PRESIDENT) |
| Authorized Official Contact | 7575436861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Practice, Ltd. 710 Liberty St Chesapeake VA 23324-2637 Ph: (757) 543-6861 | Medical Practice, Ltd. 710 Liberty St Chesapeake VA 23324-2637 Ph: (757) 543-6861 |
| NPI Number | 1609938505 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 09/29/2014 |
| Medicare PECOS PAC ID | 1557458320 |
|---|---|
| Medicare Enrollment ID | O20071026000400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609938505 | NPI | - | NPPES |
| 461191 | Other | VA | ANTHEM |
| 5882401 | Medicaid | VA | |
| 12090 | Other | VA | OPTIMA HEALTH |
| 110138225 | Other | VA | MEDICARE-RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0101023718 (Virginia) | Primary |
| Provider Name | Dharmesh K Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942264775 PECOS PAC ID: 0143259580 Enrollment ID: I20050805000822 |
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