Provider Demographics
NPI:1932197969
Name:SHISHODIA, HIMANI (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMANI
Middle Name:
Last Name:SHISHODIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 W JOPPA RD STE 310
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4685
Mailing Address - Country:US
Mailing Address - Phone:410-616-2802
Mailing Address - Fax:833-464-4300
Practice Address - Street 1:2328 W JOPPA RD STE 310
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4685
Practice Address - Country:US
Practice Address - Phone:410-616-2802
Practice Address - Fax:833-464-4300
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY220961OtherLICENSE