1174509426 NPI number — PRASHANT ROHIT SHUKLA M.D.

Table of content: PRASHANT ROHIT SHUKLA M.D. (NPI 1174509426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174509426 NPI number — PRASHANT ROHIT SHUKLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUKLA
Provider First Name:
PRASHANT
Provider Middle Name:
ROHIT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174509426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
998 HOSPITALITY WAY, SUITE 102
Provider Second Line Business Mailing Address:
BAYSIDE INTERNAL MEDICINE, LLC
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21001-1757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-297-9500
Provider Business Mailing Address Fax Number:
410-297-9016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
998 HOSPITALITY WAY, SUITE 102
Provider Second Line Business Practice Location Address:
BAYSIDE INTERNAL MEDICINE, LLC
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21001-1757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-297-9500
Provider Business Practice Location Address Fax Number:
410-297-9016
Provider Enumeration Date:
12/19/2005

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:  D48050 , 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: 529802400 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G738-0001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 489M734F . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110247432 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 54449804 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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