Healthcare Provider Details

I. General information

NPI: 1639756547
Provider Name (Legal Business Name): SHAIKH BILAL ALI IQBAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4133
  • Fax:
Mailing address:
  • Phone: 410-554-2284
  • Fax: 410-554-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018649
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1022422
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0100213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: