Provider Demographics
NPI:1376501882
Name:AMIN, SHAHRIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHRIAR
Middle Name:
Last Name:AMIN
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 1:5755 CEDAR LANE
Mailing Address - Street 2:JHCP INTENSIVIST GROUP
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-720-8695
Mailing Address - Fax:410-720-8580
Practice Address - Street 1:5755 CEDAR LANE
Practice Address - Street 2:JHCP INTENSIVIST GROUP
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-720-8695
Practice Address - Fax:410-720-8580
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62273207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406051200Medicaid
MN067935000Medicaid
MN067935000Medicaid
MD406051200Medicaid
I02510Medicare UPIN