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General NPI Number Information
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NPI Number | 1316069883
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Entity Type | Individual
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Provider Name | SYED IMRAN MOBIN SHAUKAT
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 520 UPPER CHESAPEAKE DR SUITE 313
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City | BEL AIR
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State | MD
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Zip | 21014-4339
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Country | US
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Telephone | 443-643-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 LILLY GATE LN
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City | BEL AIR
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State | MD
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Zip | 21014-2705
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Country | US
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Telephone | 410-420-0383
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | D0056679
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | D0056679
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License Number State | MD
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