Provider Demographics
NPI:1881761815
Name:SHALABY, ISMAIL AHMAD (MD PHD)
Entity type:Individual
Prefix:
First Name:ISMAIL
Middle Name:AHMAD
Last Name:SHALABY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 WEST SEMINARY AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-675-0050
Mailing Address - Fax:410-675-4692
Practice Address - Street 1:2801 HUDSON STREET
Practice Address - Street 2:UPPER LEVEL SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-675-0050
Practice Address - Fax:410-675-4692
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055532207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD704001604Medicaid
H11019Medicare UPIN
MD704001604Medicaid