Provider Demographics
NPI:1932208543
Name:SHAMIM, SHAHID (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:SHAMIM
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 10247
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-0247
Mailing Address - Country:US
Mailing Address - Phone:301-452-2116
Mailing Address - Fax:240-454-3980
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-452-2116
Practice Address - Fax:240-454-3980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD-59284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015238C82OtherMEDICARE
MD400656900Medicaid
MD400656900Medicaid