Provider Demographics
NPI:1528242765
Name:MOUTINHO SHOGAN, PRISCILLA (DO)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MOUTINHO SHOGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SILENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1358
Mailing Address - Country:US
Mailing Address - Phone:215-917-5011
Mailing Address - Fax:
Practice Address - Street 1:5 SILENTWOOD CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1358
Practice Address - Country:US
Practice Address - Phone:215-917-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011586207P00000X
MDH006810207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine