Provider Demographics
NPI:1851333884
Name:SHULDINER, ALAN R (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:SHULDINER
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-706-1623
Mailing Address - Fax:410-706-1622
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-706-1623
Practice Address - Fax:410-706-1622
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34686207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000912601Medicaid
MD480871100Medicaid
MD351661-01OtherBLUE CROSS/BLUE SHIELD
DE000912601Medicaid
MD351661-01OtherBLUE CROSS/BLUE SHIELD
MDS051645SMedicare PIN