Provider Demographics
NPI:1083908750
Name:EHAB SHALABY MD, PA
Entity Type:Organization
Organization Name:EHAB SHALABY MD, PA
Other - Org Name:MARYLAND PAIN AND SPINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALABY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-610-5814
Mailing Address - Street 1:324 E ANTIETAM ST
Mailing Address - Street 2:SUITE 306A
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5754
Mailing Address - Country:US
Mailing Address - Phone:240-469-3002
Mailing Address - Fax:240-469-3193
Practice Address - Street 1:324 E ANTIETAM ST
Practice Address - Street 2:SUITE 306A
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5754
Practice Address - Country:US
Practice Address - Phone:240-469-3002
Practice Address - Fax:240-469-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI36776Medicare UPIN
MD897LP573Medicare PIN