Provider Demographics
NPI:1356307912
Name:SHOROFSKY, ALAN MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MITCHELL
Last Name:SHOROFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-494-1317
Mailing Address - Fax:410-584-2251
Practice Address - Street 1:515 FAIRMOUNT AVE STE 330
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1317
Practice Address - Fax:410-584-2251
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD24569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD341901100Medicaid
MDH596B370Medicare PIN
157787ZR0ZMedicare PIN
MDB69760Medicare UPIN
MD157676Medicare PIN