Provider Demographics
NPI:1700839909
Name:RALSTON, SHAWN L (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:RALSTON
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 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS STRREET
Practice Address - Street 2:BLOOMBERG 8TH FLOOR SUITE 8453
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:443-287-7681
Practice Address - Fax:410-955-0761
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0526208000000X
NH15725208000000X
MDD86765208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153767202Medicaid
TX8AU894OtherBCBS
TX8AU894OtherBCBS
TX8L11316Medicare PIN