Provider Demographics
NPI:1376546069
Name:SHPAK, OLEG B (MD)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:B
Last Name:SHPAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9470 ANNAPOLIS RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3038
Mailing Address - Country:US
Mailing Address - Phone:301-577-5511
Mailing Address - Fax:301-577-1177
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:STE 210
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3038
Practice Address - Country:US
Practice Address - Phone:301-577-5511
Practice Address - Fax:301-577-1177
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0034860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD282021800Medicaid
MD282021800Medicaid
MD508298Medicare PIN