Provider Demographics
NPI:1285020115
Name:SHAHID SHAMIM,MD.,LLC.
Entity type:Organization
Organization Name:SHAHID SHAMIM,MD.,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-452-2116
Mailing Address - Street 1:PO BOX 10247
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-0247
Mailing Address - Country:US
Mailing Address - Phone:301-816-9000
Mailing Address - Fax:240-454-3980
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE # 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-816-9000
Practice Address - Fax:240-454-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD-59284261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care