Healthcare Provider Details

I. General information

NPI: 1366416299
Provider Name (Legal Business Name): MOHAMED K.M. SHAKIR
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: K.M.M SHAKIR M.D

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CENTER 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

9905 MARQUETTE DR
BETHESDA MD
20817-1749
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-5165
  • Fax: 301-295-5165
Mailing address:
  • Phone: 301-530-7278
  • Fax: 301-295-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0017600
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: