Provider Demographics
NPI:1528200201
Name:SHUKRULLAH, IRFAN (MD)
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:
Last Name:SHUKRULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N RIDGE RD
Mailing Address - Street 2:APT 204
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3390
Mailing Address - Country:US
Mailing Address - Phone:404-543-5535
Mailing Address - Fax:
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:443-559-5063
Practice Address - Fax:443-559-5078
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0076790207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology