Provider Demographics
NPI:1750747192
Name:SHMUKLARSKY, MOSHE J (MD)
Entity type:Individual
Prefix:
First Name:MOSHE
Middle Name:J
Last Name:SHMUKLARSKY
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 1:9401 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5722
Mailing Address - Country:US
Mailing Address - Phone:301-619-7955
Mailing Address - Fax:
Practice Address - Street 1:9401 BALFOUR DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5722
Practice Address - Country:US
Practice Address - Phone:301-619-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0021175OtherSTATE LICENSE NUMBER