# MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MedStar Shah Medical Group LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376340307
- **Authorized official:** ALAN ADAIR BUSTER (C.O.O.)
- **Authorized official phone:** (301) 373-7905

## Contact information

- **Practice address:** 950 E SWANN CREEK RD, FORT WASHINGTON, MD 20744-5250
- **Practice address phone:** (301) 292-7270
- **Practice address fax:** (301) 292-6432
- **Mailing address:** 24035 THREE NOTCH ROAD, HOLLYWOOD, MD 20636-4871
- **Mailing address phone:** (301) 373-7900
- **Mailing address fax:** (301) 373-6900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |
| 207ZC0006X | Clinical Pathology Physician | — | NULL | — |
| 207ZC0006X | Clinical Pathology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 02/27/2025
- **Last updated:** 08/01/2025