Provider Demographics
NPI:1033109459
Name:JERI SHUSTER, M.D., PA
Entity Type:Organization
Organization Name:JERI SHUSTER, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-730-5700
Mailing Address - Street 1:11065 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2998
Mailing Address - Country:US
Mailing Address - Phone:410-730-5700
Mailing Address - Fax:410-964-3231
Practice Address - Street 1:11065 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2998
Practice Address - Country:US
Practice Address - Phone:410-730-5700
Practice Address - Fax:410-964-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34215207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD946LMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER