Provider Demographics
NPI:1457541278
Name:SHIMKO, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:SHIMKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 S DIVISION ST
Mailing Address - Street 2:#401
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6921
Mailing Address - Country:US
Mailing Address - Phone:410-546-2133
Mailing Address - Fax:410-548-3361
Practice Address - Street 1:1342 S DIVISION ST
Practice Address - Street 2:#401
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6921
Practice Address - Country:US
Practice Address - Phone:410-546-2133
Practice Address - Fax:410-548-3361
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN50973208800000X
MDD0073462208800000X
DEC1-0009994208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00645889OtherMEDICARE, RAILROAD
MNENROLLEDMedicaid
MNENROLLEDMedicaid