Provider Demographics
NPI:1730155896
Name:SHAH, MEHUL JITENDRA (DPM)
Entity type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:JITENDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-0616
Mailing Address - Country:US
Mailing Address - Phone:703-443-2120
Mailing Address - Fax:
Practice Address - Street 1:224A CORNWALL ST NW
Practice Address - Street 2:LOUDOUN COMMUNITY HEALTH CENTER
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2701
Practice Address - Country:US
Practice Address - Phone:703-443-2120
Practice Address - Fax:703-443-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300893213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJ4630001OtherCAREFIRST BC/BS
VA1841465291OtherGROUP NPI
VA350392OtherANTHEM BC/BS
VA3854800OtherCIGNA
VA7980784OtherAETNA
VA6126450001Medicare NSC
VAV05587Medicare UPIN
VA00X742Medicare PIN