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General NPI Number Information
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NPI Number | 1548720550
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Entity Type | Individual
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Provider Name | MATTHEW JOHN SHADLE DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 22 S GREENE ST DEPT. OF RADIOLOGY
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City | BALTIMORE
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State | MD
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Zip | 21201-1544
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Country | US
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Telephone | 410-328-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 22 S GREENE ST. DEPT. OF RADIOLOGY
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City | BALTIMORE
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State | MD
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Zip | 21201-1544
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C2-0024024
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS024784
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | H0098963
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License Number State | MD
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