Provider Demographics
NPI:1568720720
Name:SHAMS, MORTADA (MD)
Entity Type:Individual
Prefix:DR
First Name:MORTADA
Middle Name:
Last Name:SHAMS
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 1:3300 GALLOWS ROAD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-776-3582
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS ROAD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-776-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61050051207RC0000X
VA0101257699208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty