Healthcare Provider Details

I. General information

NPI: 1073993796
Provider Name (Legal Business Name): RITA SHKULLAKU MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3179 BRAVERTON ST STE 202
EDGEWATER MD
21037-2667
US

IV. Provider business mailing address

718 PEGGY STEWART CT
DAVIDSONVILLE MD
21035-1335
US

V. Phone/Fax

Practice location:
  • Phone: 410-934-0650
  • Fax:
Mailing address:
  • Phone: 410-934-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0074339
License Number StateMD

VIII. Authorized Official

Name: DR. RITA J SHKULLAKU
Title or Position: SOLE OWNER
Credential: MD
Phone: 410-897-9841