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General NPI Number Information
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NPI Number | 1043393531
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Entity Type | Individual
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Provider Name | FUAD SHATILA MD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2232 WILLBORN AVE
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City | SOUTH BOSTON
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State | VA
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Zip | 24592
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Country | US
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Telephone | 434-517-3705
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Fax |
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Provider Business Mailing Address
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Address Line | 1861 E NORTHERN PARKWAY
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City | BALTIMORE
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State | MD
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Zip | 21239-2107
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Country | US
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Telephone | 443-763-1170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME27115
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 9316
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101240399
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License Number State | VA
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