Healthcare Provider Details

I. General information

NPI: 1194138131
Provider Name (Legal Business Name): MADEEHA SHAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 N RIDGE RD
ELLICOTT CITY MD
21043-3464
US

IV. Provider business mailing address

2850 N RIDGE RD
ELLICOTT CITY MD
21043-3464
US

V. Phone/Fax

Practice location:
  • Phone: 410-418-8550
  • Fax: 410-418-8552
Mailing address:
  • Phone: 410-418-8550
  • Fax: 410-418-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0087775
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number44646
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: