Provider Demographics
NPI:1922199405
Name:ABATE, SHASTINE (MD)
Entity Type:Individual
Prefix:
First Name:SHASTINE
Middle Name:
Last Name:ABATE
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 1:7004 SECURITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2572
Mailing Address - Country:US
Mailing Address - Phone:410-277-3490
Mailing Address - Fax:410-277-4823
Practice Address - Street 1:7004 SECURITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2572
Practice Address - Country:US
Practice Address - Phone:410-277-3490
Practice Address - Fax:410-277-4823
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50296207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD50296OtherSTATE LICENSE
MDM41040OtherCDS
MD978M 782FOtherMEDICARE INDIVIDUAL
MD978M 782FOtherMEDICARE INDIVIDUAL
MDG35432Medicare UPIN