Provider Demographics
NPI:1821063108
Name:QURESHI, SHAKAIB S (MD)
Entity Type:Individual
Prefix:
First Name:SHAKAIB
Middle Name:S
Last Name:QURESHI
Suffix:
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 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:302-830-5297
Mailing Address - Fax:302-623-4395
Practice Address - Street 1:3301 LANCASTER PIKE
Practice Address - Street 2:SUITE 9
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1436
Practice Address - Country:US
Practice Address - Phone:302-830-5297
Practice Address - Fax:302-656-5270
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007826207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1215975149Medicaid
PAP00308224OtherRAILROAD MEDICARE
PAP00308224OtherRAILROAD MEDICARE
H86339Medicare UPIN