Provider Demographics
NPI:1639602071
Name:SHU, ALBERT CHANCELLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHANCELLOR
Last Name:SHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2233 WISCONSIN AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4104
Mailing Address - Country:US
Mailing Address - Phone:202-741-1250
Mailing Address - Fax:877-303-1460
Practice Address - Street 1:2233 WISCONSIN AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4104
Practice Address - Country:US
Practice Address - Phone:202-714-1250
Practice Address - Fax:877-303-1460
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KYS03-009-797390200000X
DCMD210002623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program