Provider Demographics
NPI:1174509426
Name:SHUKLA, PRASHANT ROHIT (MD)
Entity Type:Individual
Prefix:
First Name:PRASHANT
Middle Name:ROHIT
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:998 HOSPITALITY WAY, SUITE 102
Mailing Address - Street 2:BAYSIDE INTERNAL MEDICINE, LLC
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1757
Mailing Address - Country:US
Mailing Address - Phone:410-297-9500
Mailing Address - Fax:410-297-9016
Practice Address - Street 1:998 HOSPITALITY WAY, SUITE 102
Practice Address - Street 2:BAYSIDE INTERNAL MEDICINE, LLC
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1757
Practice Address - Country:US
Practice Address - Phone:410-297-9500
Practice Address - Fax:410-297-9016
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-06-28
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Provider Licenses
StateLicense IDTaxonomies
MDD48050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD529802400OtherMEDICAL ASSISTANCE
DCG738-0001OtherCAREFIRST
MD489M734FOtherMEDICARE
GA110247432OtherRAILROAD MEDICARE
MD54449804OtherCAREFIRST
MD54449804OtherCAREFIRST