Provider Demographics
NPI:1487644894
Name:SHUSTER, JERI (MD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2979
Mailing Address - Country:US
Mailing Address - Phone:410-730-5700
Mailing Address - Fax:410-964-3231
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2979
Practice Address - Country:US
Practice Address - Phone:410-730-5700
Practice Address - Fax:410-964-3231
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2011-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD34215207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD476091300Medicaid
MD476091300Medicaid
MDD76588Medicare UPIN