Provider Demographics
NPI:1174676969
Name:SHAULL, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNE
Last Name:SHAULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SHAULL LOTLIKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:269 PENINSULA FARM RD STE F
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1013
Mailing Address - Country:US
Mailing Address - Phone:410-518-9808
Mailing Address - Fax:410-518-9842
Practice Address - Street 1:269 PENINSULA FARM RD STE F
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1013
Practice Address - Country:US
Practice Address - Phone:410-518-9808
Practice Address - Fax:410-518-9842
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD437290ZDDBMedicare PIN
MD437244YWV2Medicare PIN
MD437290YVZMedicare PIN
MDG28283Medicare UPIN