Provider Demographics
NPI:1811917156
Name:SHUMAN, MARTIN JERRY (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JERRY
Last Name:SHUMAN
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 1:300 HOSPITAL DR
Mailing Address - Street 2:STE 121
Mailing Address - City:GLEN BERNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-761-0900
Mailing Address - Fax:410-761-0351
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:STE 121
Practice Address - City:GLEN BERNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-761-0900
Practice Address - Fax:410-761-0353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0008334207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76690Medicare UPIN
5210Medicare ID - Type Unspecified