Provider Demographics
NPI:1255493011
Name:SHAMIM, EJAZ ANWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EJAZ
Middle Name:ANWAR
Last Name:SHAMIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 MERCANTILE LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5374
Mailing Address - Country:US
Mailing Address - Phone:301-386-6850
Mailing Address - Fax:301-386-6851
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-386-6850
Practice Address - Fax:301-386-6851
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012382222084N0400X
DCMD0369442084N0400X
MDD688002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology