Provider Demographics
NPI:1922087857
Name:SHAMMAS, NICOLAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:W
Last Name:SHAMMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1236 E RUSHOLME ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2473
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-888-0499
Practice Address - Street 1:1236 E RUSHOLME ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2473
Practice Address - Country:US
Practice Address - Phone:563-324-2992
Practice Address - Fax:563-888-0499
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27303207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060032125OtherMEDICARE RAILROAD
IA2060558Medicaid
IA2060558Medicaid
IA51114Medicare PIN