Healthcare Provider Details

I. General information

NPI: 1407054349
Provider Name (Legal Business Name): SHAH ASSOCIATES MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHARLOTTE HALL MEDICAL CENTER 37767 MARKET DR. 2ND FLOOR
CHARLOTTE HALL MD
20622
US

IV. Provider business mailing address

24035 THREE NOTCH RD P O BOX 640
HOLLYWOOD MD
20636-4871
US

V. Phone/Fax

Practice location:
  • Phone: 130-188-4732
  • Fax: 301-884-8663
Mailing address:
  • Phone: 301-373-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSIE HOLMAN
Title or Position: CLINIC COORDINATOR
Credential:
Phone: 301-373-7911