Provider Demographics
NPI:1790755635
Name:KAPOOR, SHIV III (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIV
Middle Name:
Last Name:KAPOOR
Suffix:III
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:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:301 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-9594
Practice Address - Fax:410-783-5575
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD49712080N0001X
MDD507752080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413107000Medicaid
SD6701500Medicaid
SD40019Medicare ID - Type UnspecifiedINDIVIDUAL #
SD6701500Medicaid
MD413107000Medicaid