Healthcare Provider Details

I. General information

NPI: 1811472038
Provider Name (Legal Business Name): SHANTI DAVID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GARRISON BLVD STE 100
BALTIMORE MD
21216-2308
US

IV. Provider business mailing address

2300 GARRISON BLVD STE 100
BALTIMORE MD
21216-2308
US

V. Phone/Fax

Practice location:
  • Phone: 410-945-2289
  • Fax: 410-945-4255
Mailing address:
  • Phone: 410-945-2289
  • Fax: 410-945-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANTI R DAVID
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 410-945-2289