Provider Demographics
NPI:1013939198
Name:SOUDAN, ABDUL SHAHEED (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:SHAHEED
Last Name:SOUDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-290-9191
Mailing Address - Fax:410-290-7330
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:STE 106
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5248
Practice Address - Country:US
Practice Address - Phone:410-290-9191
Practice Address - Fax:410-290-7330
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063349208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00414437OtherRR MEDICARE
MDG02677D02Medicare PIN
MDI66474Medicare UPIN
MD010828600Medicaid
MD64742602OtherBLUE CROSS
MD165PP088Medicare PIN
MDK9070009OtherBLUE CROSS REGIONAL