Provider Demographics
NPI:1396723805
Name:JOSEPHS, SHELBY (MD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:JOSEPHS
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 1:6000 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 615
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3803
Mailing Address - Country:US
Mailing Address - Phone:240-747-5750
Mailing Address - Fax:240-747-5753
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 615
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:240-747-5750
Practice Address - Fax:240-747-5753
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031821207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83248Medicare UPIN
637728Medicare ID - Type Unspecified