Provider Demographics
NPI:1477658813
Name:SHAO, XIANGRONG (MD)
Entity Type:Individual
Prefix:
First Name:XIANGRONG
Middle Name:
Last Name:SHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LOCH RAVEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-605-7552
Mailing Address - Fax:
Practice Address - Street 1:3900 LOCH RAVEN BLVD.
Practice Address - Street 2:BRECC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7526
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0056508207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM53029OtherCDS
MD400271700Medicaid
MDBS7766403OtherDEA
MD400271700Medicaid