Healthcare Provider Details

I. General information

NPI: 1487644894
Provider Name (Legal Business Name): JERI SHUSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY SUITE 204
COLUMBIA MD
21044-2979
US

IV. Provider business mailing address

11085 LITTLE PATUXENT PKWY SUITE 204
COLUMBIA MD
21044-2979
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-5700
  • Fax: 410-964-3231
Mailing address:
  • Phone: 410-730-5700
  • Fax: 410-964-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD34215
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: