Provider Demographics
NPI:1457314981
Name:SHIMOURA, STEVEN MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARC
Last Name:SHIMOURA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1519
Mailing Address - Country:US
Mailing Address - Phone:301-570-1333
Mailing Address - Fax:301-570-5640
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 300
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-570-1333
Practice Address - Fax:301-570-5640
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0039071207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE23126Medicare UPIN
MD965L547EMedicare PIN
MDG00459Medicare PIN