Healthcare Provider Details

I. General information

NPI: 1174513519
Provider Name (Legal Business Name): JERI SHUSTER, M.D., WOMEN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11065 LITTLE PATUXENT PKWY SUITE 200
COLUMBIA MD
21044-2998
US

IV. Provider business mailing address

11065 LITTLE PATUXENT PKWY SUITE 200
COLUMBIA MD
21044-2998
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberD34215
License Number StateMD

VIII. Authorized Official

Name: DR. JERI SHUSTER
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 410-730-5700