Provider Demographics
NPI:1609953140
Name:SHAMS PIRZADEH, ABDOLLAH (MD)
Entity Type:Individual
Prefix:
First Name:ABDOLLAH
Middle Name:
Last Name:SHAMS PIRZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:
Other - Last Name:SHAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:716 MAIDEN CHOICE LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5943
Mailing Address - Country:US
Mailing Address - Phone:410-788-2000
Mailing Address - Fax:410-465-9881
Practice Address - Street 1:716 MAIDEN CHOICE LN
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5943
Practice Address - Country:US
Practice Address - Phone:410-788-2000
Practice Address - Fax:410-455-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014789174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222430OtherMAMSI/OPT CHOICE
MDW0410001OtherFEDERAL BCBS
MA00941-1800Medicaid
MD36198001OtherBLUE CROSS BLUE SHIELD
MD521190322OtherTAX ID #
MD111923152OtherRAILROAD MEDICARE
MDC49316Medicare UPIN
MDW0410001OtherFEDERAL BCBS