Provider Demographics
NPI:1770716623
Name:SHAMSAD BEGUM MD PA
Entity type:Organization
Organization Name:SHAMSAD BEGUM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMSAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-676-5382
Mailing Address - Street 1:1195 N MILITARY TRL
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6058
Mailing Address - Country:US
Mailing Address - Phone:561-683-4100
Mailing Address - Fax:561-683-4100
Practice Address - Street 1:1195 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6058
Practice Address - Country:US
Practice Address - Phone:561-683-4100
Practice Address - Fax:561-683-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME7377870261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006570100OtherGRP MEDICAID ID
FLDN212AOtherMEDICARE GRP PTAN
FL257951100Medicaid
FLDN212AOtherMEDICARE GRP NPI
FLH08092Medicare UPIN
FL46657Medicare PIN