Provider Demographics
NPI:1124068721
Name:SHOROFSKY, STEPHEN ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROSS
Last Name:SHOROFSKY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5793
Mailing Address - Fax:410-328-0248
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5793
Practice Address - Fax:410-328-0248
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44169207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1124068721Medicaid
MD526957-01OtherBLUE CROSS/BLUE SHIELD
VA5849608Medicaid
DC037160600Medicaid
NC7610152Medicaid
WV1805323000Medicaid
MD203101900Medicaid
VA5849608Medicaid
MD988GMedicare PIN
DE1124068721Medicaid
MDHF02Medicare PIN