Healthcare Provider Details

I. General information

NPI: 1881761815
Provider Name (Legal Business Name): ISMAIL AHMAD SHALABY MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 HUDSON STREET UPPER LEVEL SUITE C
BALTIMORE MD
21224
US

IV. Provider business mailing address

1349 WEST SEMINARY AVENUE
LUTHERVILLE MD
21093
US

V. Phone/Fax

Practice location:
  • Phone: 410-675-0050
  • Fax: 410-675-4692
Mailing address:
  • Phone: 410-675-0050
  • Fax: 410-675-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0055532
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: