Healthcare Provider Details

I. General information

NPI: 1649397787
Provider Name (Legal Business Name): SHAHIN OVEISI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 16TH ST
SILVER SPRING MD
20910-2261
US

IV. Provider business mailing address

7250 PARKWAY DR STE 500
HANOVER MD
21076-1343
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-4682
  • Fax:
Mailing address:
  • Phone: 443-949-0814
  • Fax: 443-949-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT186463
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101257614
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: