Healthcare Provider Details

I. General information

NPI: 1578597845
Provider Name (Legal Business Name): NEELOFUR Q SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 TELSA DR SUITE A & B
BOWIE MD
20715-4406
US

IV. Provider business mailing address

7227 HANOVER PKWY STE A
GREENBELT MD
20770-2025
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-6860
  • Fax: 301-805-0755
Mailing address:
  • Phone: 888-846-5527
  • Fax: 607-324-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD0034818
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD17408
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: