Provider Demographics
NPI:1285619312
Name:DIDOLKAR, SHAILAJA M (MD)
Entity type:Individual
Prefix:DR
First Name:SHAILAJA
Middle Name:M
Last Name:DIDOLKAR
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 1:54 SCOTT ADAM RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3216
Mailing Address - Country:US
Mailing Address - Phone:410-683-1440
Mailing Address - Fax:410-683-1308
Practice Address - Street 1:54 SCOTT ADAM RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3216
Practice Address - Country:US
Practice Address - Phone:410-683-1440
Practice Address - Fax:410-683-1308
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022106207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2801OtherBLUE SHIELD
MD2801Medicare ID - Type Unspecified
MD2801Medicare PIN
MD2801OtherBLUE SHIELD