1710182498 NPI number — SHAFQUAT MERAJ, M.D., P.A.

Table of content: (NPI 1710182498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710182498 NPI number — SHAFQUAT MERAJ, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAFQUAT MERAJ, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1710182498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-4116
Provider Business Mailing Address Fax Number:
410-414-8480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 PRINCE FREDERICK BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-231-4666
Provider Business Practice Location Address Fax Number:
410-414-8480
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERAJ
Authorized Official First Name:
SHAFQUAT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-231-4666

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0060084 , 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: 387CSH . This is a "BLUE SHIELD OF MD GRP ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K983 . This is a "BLUE SHIELD OF NCA GRP ID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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