Provider Demographics
NPI:1932186764
Name:SHAWN DHILLON, M.D., P.C.
Entity Type:Organization
Organization Name:SHAWN DHILLON, M.D., P.C.
Other - Org Name:CALVERT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:410-814-3067
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:SUITE 555
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6518
Mailing Address - Country:US
Mailing Address - Phone:410-261-8800
Mailing Address - Fax:410-261-8813
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE 555
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6518
Practice Address - Country:US
Practice Address - Phone:410-261-8800
Practice Address - Fax:410-261-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01595111N00000X
MDD0058860207R00000X
MDC0004180363A00000X
MDC0000420363A00000X
MDR123281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211PMedicare ID - Type Unspecified