Healthcare Provider Details

I. General information

NPI: 1275943425
Provider Name (Legal Business Name): HASAN MUHAMMAD SHIHAB MBCHB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR DEPARTMENT OF FAMILY MEDICINE
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR DEPARTMENT OF FAMILY MEDICINE
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2000
  • Fax: 443-777-2034
Mailing address:
  • Phone: 443-777-2000
  • Fax: 443-777-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD97958
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD97958
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD97958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: