Provider Demographics
NPI:1154703585
Name:RAZMDJOU, SHADI (MD)
Entity type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:RAZMDJOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 RIDGELY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1083
Mailing Address - Country:US
Mailing Address - Phone:410-224-4887
Mailing Address - Fax:410-224-1428
Practice Address - Street 1:621 RIDGELY AVE STE 201
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1083
Practice Address - Country:US
Practice Address - Phone:410-224-4887
Practice Address - Fax:410-224-1428
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0092146207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty