Healthcare Provider Details

I. General information

NPI: 1457980955
Provider Name (Legal Business Name): FAISAL SHABBIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219A CORPORATE CT
ELLICOTT CITY MD
21042-2247
US

IV. Provider business mailing address

3219A CORPORATE CT
ELLICOTT CITY MD
21042-2247
US

V. Phone/Fax

Practice location:
  • Phone: 667-450-8933
  • Fax:
Mailing address:
  • Phone: 667-450-8933
  • Fax: 667-450-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25IA12658300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD96574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: