Provider Demographics
NPI:1356428197
Name:SHAH, VARSHA D (MD)
Entity type:Individual
Prefix:DR
First Name:VARSHA
Middle Name:D
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 DIANE CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4367
Mailing Address - Country:US
Mailing Address - Phone:972-436-7424
Mailing Address - Fax:972-219-0343
Practice Address - Street 1:1175 DIANE CIR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4367
Practice Address - Country:US
Practice Address - Phone:972-436-7424
Practice Address - Fax:972-219-0343
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ489OtherBLUE CROSS
TX8AJ489OtherBLUE CROSS
TXTXB138757Medicare PIN