Provider Demographics
NPI:1316068083
Name:OLEG B. SHPAK, MD, PA
Entity type:Organization
Organization Name:OLEG B. SHPAK, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHPAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-577-5511
Mailing Address - Street 1:9470 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3025
Mailing Address - Country:US
Mailing Address - Phone:301-577-5511
Mailing Address - Fax:301-577-1177
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-577-5511
Practice Address - Fax:301-577-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD508298Medicare PIN
MDB95143Medicare UPIN