Provider Demographics
NPI:1336315803
Name:SHUSHAN, ALEXANDER DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:DONALD
Last Name:SHUSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8902
Mailing Address - Country:US
Mailing Address - Phone:667-204-7000
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-268-8862
Practice Address - Fax:410-280-4701
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235422207X00000X, 207XS0106X
MDD69115207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC160713ZDTRMedicare UPIN
MD160711ZDR9Medicare UPIN