Provider Demographics
NPI:1275591141
Name:KARIM, SHAHANA NASREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHANA
Middle Name:NASREEN
Last Name:KARIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAHANA
Other - Middle Name:
Other - Last Name:NASREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1740 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1514
Mailing Address - Country:US
Mailing Address - Phone:215-732-0876
Mailing Address - Fax:215-732-1383
Practice Address - Street 1:1740 SOUTH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1514
Practice Address - Country:US
Practice Address - Phone:215-732-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066934-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017504080005Medicaid
PA0017504080005Medicaid
PA025482Medicare PIN