1093546426 NPI number — MRS. HIMJA V. SHAH CRNP-OB/GYN

Table of content: MRS. HIMJA V. SHAH CRNP-OB/GYN (NPI 1093546426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093546426 NPI number — MRS. HIMJA V. SHAH CRNP-OB/GYN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
HIMJA
Provider Middle Name:
V.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP-OB/GYN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093546426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
689 RAVENWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21060-7592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
433-845-3930
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 MEDICAL PKWY STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-266-7755
Provider Business Practice Location Address Fax Number:
410-266-1141
Provider Enumeration Date:
08/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  R226816 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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