Healthcare Provider Details

I. General information

NPI: 1891727913
Provider Name (Legal Business Name): SHAMUS RUSSELL CARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S GREENE ST STOLER CANCER PAVILION
BALTIMORE MD
21201-1504
US

IV. Provider business mailing address

PO BOX 64226
BALTIMORE MD
21264-4226
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-8663
  • Fax:
Mailing address:
  • Phone: 667-214-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD418012
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8054539-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number8054539-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD78550
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: