Provider Demographics
NPI:1073993796
Name:RITA SHKULLAKU MD PC
Entity Type:Organization
Organization Name:RITA SHKULLAKU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHKULLAKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-897-9841
Mailing Address - Street 1:23 PIERSIDE DR
Mailing Address - Street 2:APT 237
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5463
Mailing Address - Country:US
Mailing Address - Phone:410-897-9841
Mailing Address - Fax:410-897-9852
Practice Address - Street 1:23 PIERSIDE DR
Practice Address - Street 2:APT 237
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5463
Practice Address - Country:US
Practice Address - Phone:410-897-9841
Practice Address - Fax:410-897-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0074339OtherOWNER STATE LICENSE