MEDICARE: JOHN A SHUTTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0030020	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679578983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A SHUTTA MD

Provider Business Mailing Address
First Line	:	PO BOX 37086
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3086
Country	:	US
Telephone Number	:	240-439-8812
Fax Number	:	301-898-5230

Provider Business Practice Location Address
First Line	:	15 E FREDERICK ST
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8234
Country	:	US
Telephone Number	:	301-898-5200
Fax Number	:	301-898-5230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	05/20/2020

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Directions to “ JOHN A SHUTTA MD” Practice Location

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