Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | LL870 | MD |
N | 1223P0106X | Oral and Maxillofacial Pathology | LL870 | MD |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | LL870 | MD |
NPI | 1679912711 |
---|---|
Provider Name | Dr. Ehab A Shehata |
First Address | Baltimore, MD 21201-1510 |
Second Address | Baltimore, MD 21201-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 16/08/2020 |