Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 235422 | MA |
N | 207X00000X | Orthopaedic Surgeon | D69115 | MD |
N | 207XS0106X | Orthopaedic Hand Surgeon | 235422 | MA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | D69115 | MD |
NPI | 1336315803 |
---|---|
Provider Name | Dr. Alexander Donald Shushan |
First Address | Annapolis, MD 21401-8902 |
Second Address | Annapolis, MD 21401-3742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 16/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160711ZDR9 | (02) | MD |
160713ZDTR | (02) | DC |