Provider Demographics
NPI:1316246598
Name:SHKULLAKU, MELSJAN (MD)
Entity type:Individual
Prefix:
First Name:MELSJAN
Middle Name:
Last Name:SHKULLAKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LUBRANO DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7568
Mailing Address - Country:US
Mailing Address - Phone:443-607-2299
Mailing Address - Fax:443-782-3488
Practice Address - Street 1:129 LUBRANO DR STE 301
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7568
Practice Address - Country:US
Practice Address - Phone:443-607-2299
Practice Address - Fax:443-782-3488
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78055208M00000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422807300Medicaid
MDS062-0546OtherCAREFIRST BC/BS
MDS062-0546OtherCAREFIRST BC/BS