Provider Demographics
NPI:1780853325
Name:SHORE PSYCHIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SHORE PSYCHIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-820-4005
Mailing Address - Street 1:8221 TEAL DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7227
Mailing Address - Country:US
Mailing Address - Phone:410-820-4005
Mailing Address - Fax:410-820-4008
Practice Address - Street 1:8221 TEAL DR
Practice Address - Street 2:SUITE 406
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7227
Practice Address - Country:US
Practice Address - Phone:410-820-4005
Practice Address - Fax:410-820-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040200103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260019170OtherPALMETTO GBA-RAILROAD MEDICARE
MD359LMedicare PIN