Provider Demographics
NPI:1972783926
Name:SHASTINE ABATE MD PA
Entity Type:Organization
Organization Name:SHASTINE ABATE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHASTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-277-3490
Mailing Address - Street 1:7004 SECURITY BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2557
Mailing Address - Country:US
Mailing Address - Phone:410-277-3490
Mailing Address - Fax:410-277-4823
Practice Address - Street 1:7004 SECURITY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2557
Practice Address - Country:US
Practice Address - Phone:410-277-3490
Practice Address - Fax:410-277-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50296207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM41040OtherCDS
MDD50296OtherMD LICENSE
MDD50296OtherMD LICENSE
MDBA4927426OtherDEA
MDD50296OtherMD LICENSE