Provider Demographics
NPI:1225022320
Name:SHAMSHAD, FAISAL (MD)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:SHAMSHAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-4478
Mailing Address - Fax:603-740-2244
Practice Address - Street 1:19 OLD ROLLINSFORD RD
Practice Address - Street 2:BUILDING B
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2807
Practice Address - Country:US
Practice Address - Phone:603-516-4265
Practice Address - Fax:603-740-2173
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08648200207P00000X, 207RC0000X, 207RI0011X
TNMD27662207R00000X
PAMD446195207RI0011X
NHLT-3476207RI0011X
MDD89714207RI0011X
ORMD152784207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277504200Medicaid
TN3098068Medicaid
FL93113OtherBLUE SHIELD
TN3098068Medicaid
FLAA644YMedicare PIN