Provider Demographics
NPI:1487631057
Name:SHADE, ELIZABETH F (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:F
Last Name:SHADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6573
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:410-280-6515
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0003OtherCAREFIRST BCBS
MD53083103OtherCAREFIRST BCBS
MD5886085OtherAETNA PPO
MD3377019OtherAETNA HMO
MD3377019OtherAETNA HMO
MD53083103OtherCAREFIRST BCBS