1649214529 NPI number — DR. AMIR H SHAHLAEE MD

Table of content: DR. AMIR H SHAHLAEE MD (NPI 1649214529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649214529 NPI number — DR. AMIR H SHAHLAEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAHLAEE
Provider First Name:
AMIR
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649214529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11002 VEIRS MILL ROAD, SUITE 414
Provider Second Line Business Mailing Address:
INSTITUTE FOR ASTHMA AND ALLERGY
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-962-5800
Provider Business Mailing Address Fax Number:
301-962-9585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4534A JOHN MARR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-962-5800
Provider Business Practice Location Address Fax Number:
301-962-9585
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  D57508 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X , with the licence number: ME92043 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: D0057508 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 271425600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 027555700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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