Provider Demographics
NPI:1023821592
Name:SHAH DERMATOLOGY LLC
Entity type:Organization
Organization Name:SHAH DERMATOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-373-7318
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0640
Mailing Address - Country:US
Mailing Address - Phone:240-448-2970
Mailing Address - Fax:301-638-7257
Practice Address - Street 1:10 SAINT PATRICK'S DRIVE
Practice Address - Street 2:SPECIALTIES II 3RD FLOOR
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4572
Practice Address - Country:US
Practice Address - Phone:240-448-2970
Practice Address - Fax:301-638-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty