1386629673 NPI number — SHAMSAD BEGUM MD

Table of content: SHAMSAD BEGUM MD (NPI 1386629673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386629673 NPI number — SHAMSAD BEGUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEGUM
Provider First Name:
SHAMSAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1386629673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1195 N MILITARY TRL
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33409-6058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-683-4100
Provider Business Mailing Address Fax Number:
561-683-4755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1195 N MILITARY TRL
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409-6058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-683-4100
Provider Business Practice Location Address Fax Number:
561-683-4755
Provider Enumeration Date:
12/09/2005

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:  ME7377870 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006570100 . This is a "GRP MEDICAID ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DN212A . This is a "MEDICARE GRP PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 257951100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770716623 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650975960 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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