Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | D0021843 | MD |
NPI | 1043396633 |
---|---|
Provider Name | Mushtaq Shah |
First Address | Greenbelt, MD 20770-2025 |
Second Address | Greenbelt, MD 20770-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
794011400 | (05) | MD |
C88824 | (02) | MD |