Basic Information
Provider Information
NPI: 1003000126
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENKESHAFI
FirstName: ARDALAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 213 S JEFFERSON ST STE 625
Address2:  
City: ROANOKE
State: VA
PostalCode: 240111713
CountryCode: US
TelephoneNumber: 5402245516
FaxNumber: 5402245684
Practice Location
Address1: 2900 LAMB CIR
Address2:  
City: CHRISTIANSBURG
State: VA
PostalCode: 240736344
CountryCode: US
TelephoneNumber: 5407312000
FaxNumber: 5407312659
Other Information
ProviderEnumerationDate: 08/31/2007
LastUpdateDate: 01/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101254037VAY Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XD0000290MDN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XD0068455MDN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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