Provider Demographics
NPI:1063496586
Name:SHAHID, ABDUL QUDOOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:QUDOOS
Last Name:SHAHID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340453
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-0453
Mailing Address - Country:US
Mailing Address - Phone:937-280-4970
Mailing Address - Fax:937-630-4578
Practice Address - Street 1:2619 COMMONS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3840
Practice Address - Country:US
Practice Address - Phone:937-280-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085482207L00000X, 207LH0002X, 207LP2900X
OK21937207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2628428Medicaid
OH2628428Medicaid