1790857688 NPI number — DR. HUMA SHAKIL M.D.

Table of content: DR. HUMA SHAKIL M.D. (NPI 1790857688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790857688 NPI number — DR. HUMA SHAKIL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAKIL
Provider First Name:
HUMA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAKIL
Provider Other First Name:
HUMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790857688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 KENT AVE
Provider Second Line Business Mailing Address:
SUITE #204
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-3794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-777-7300
Provider Business Mailing Address Fax Number:
301-723-4000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 KENT AVE
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-3794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-777-7300
Provider Business Practice Location Address Fax Number:
301-723-4000
Provider Enumeration Date:
11/15/2006

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: 207R00000X , with the licence number:  D463646 , 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: 149631000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260581710 . This is a "MISC INS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 260581710 . This is a "COMM INS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 53295002 . This is a "BCBS-NEW" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: M6720001 . This is a "BCBS-FED & BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 236826 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P11632 . This is a "BCBS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P18192 . This is a "BCBS POS-NEW" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 836826 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 53295001 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R9110001 . This is a "FEDERAL BCBS & BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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