Provider Demographics
NPI:1497726673
Name:DADA, SHAMIM (MD)
Entity Type:Individual
Prefix:
First Name:SHAMIM
Middle Name:
Last Name:DADA
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 1:322 E ANTIETAM ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5794
Mailing Address - Country:US
Mailing Address - Phone:301-739-6147
Mailing Address - Fax:301-739-6163
Practice Address - Street 1:322 E ANTIETAM ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5794
Practice Address - Country:US
Practice Address - Phone:301-739-6147
Practice Address - Fax:301-739-6163
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD684412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000490229OtherANTHEM PROVIDER NUMBER
IN11383676OtherCAQH
INP00388514OtherRAILROAD MEDICARE
IN200188770Medicaid
INP00388514OtherRAILROAD MEDICARE
IN248640JJMedicare PIN
IN815150AAAMedicare PIN