Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D40343 | MD |
N | 207QS0010X | Family Doctor - Sports Medicine | D40343 | MD |
NPI | 1134355050 |
---|---|
Provider Name | Donald Shell |
First Address | Largo, MD 20774-5329 |
Second Address | Largo, MD 20774-5329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |