Provider Demographics
NPI:1568492783
Name:KERMAN, SHELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:KERMAN
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 1:22610 GATEWAY CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-2007
Mailing Address - Country:US
Mailing Address - Phone:301-230-7575
Mailing Address - Fax:240-686-1515
Practice Address - Street 1:22610 GATEWAY CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-2007
Practice Address - Country:US
Practice Address - Phone:301-230-7575
Practice Address - Fax:240-686-1515
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028912207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018064D43Medicare ID - Type Unspecified
MDC87864Medicare UPIN