Provider Demographics
NPI:1407006695
Name:SIDNEY SHANKMAN, MD PA
Entity Type:Organization
Organization Name:SIDNEY SHANKMAN, MD PA
Other - Org Name:SIDNEY SHANKMAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-585-5365
Mailing Address - Street 1:8611 2ND AVE
Mailing Address - Street 2:301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3372
Mailing Address - Country:US
Mailing Address - Phone:301-585-5365
Mailing Address - Fax:301-588-4621
Practice Address - Street 1:8611 2ND AVE
Practice Address - Street 2:301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3372
Practice Address - Country:US
Practice Address - Phone:301-585-5365
Practice Address - Fax:301-588-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD172860Medicare UPIN