# 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:** 1417754458
- **Authorized official:** ALAN ADAIR BUSTER (C.O.O.)
- **Authorized official phone:** (301) 373-7905

## Contact information

- **Practice address:** 22650 CEDAR LANE CT, LEONARDTOWN, MD 20650-3965
- **Practice address phone:** (301) 475-5021
- **Practice address fax:** (301) 997-0264
- **Mailing address:** 24035 THREE NOTCH RD, HOLLYWOOD, MD 20636-4871
- **Mailing address phone:** (301) 373-7900
- **Mailing address fax:** (301) 373-6900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/27/2025
- **Last updated:** 08/14/2025