Provider Demographics
NPI:1194138131
Name:SHAMS, MADEEHA (MD)
Entity type:Individual
Prefix:
First Name:MADEEHA
Middle Name:
Last Name:SHAMS
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 1:2850 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3464
Mailing Address - Country:US
Mailing Address - Phone:410-418-8550
Mailing Address - Fax:410-418-8552
Practice Address - Street 1:2850 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3464
Practice Address - Country:US
Practice Address - Phone:410-418-8550
Practice Address - Fax:410-418-8552
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44646208M00000X
MDD0087775207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty