Provider Demographics
NPI:1164791927
Name:SHABAN, JAMAAL H (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMAAL
Middle Name:H
Last Name:SHABAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 WILKENS AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5074
Mailing Address - Country:US
Mailing Address - Phone:443-574-8500
Mailing Address - Fax:410-719-0094
Practice Address - Street 1:120 WHITE HORSE PIKE STE 103B
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1938
Practice Address - Country:US
Practice Address - Phone:856-546-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH84267208600000X
NJ25MB09527900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery