Provider Demographics
NPI:1043407299
Name:STEVEN M SHIMOURA MD PA
Entity Type:Organization
Organization Name:STEVEN M SHIMOURA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHIMOURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-570-1333
Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 123
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-570-1333
Mailing Address - Fax:301-570-5640
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 123
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-570-1333
Practice Address - Fax:301-570-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039071207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00459Medicare PIN
MD965LMedicare PIN