# 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:** 1790582740
- **Authorized official:** ALAN ADAIR BUSTER (C.O.O.)
- **Authorized official phone:** (301) 373-7905

## Contact information

- **Practice address:** 4240 ALTAMONT PLACE, WHITE PLAINS, MD 20695-3052
- **Practice address phone:** (240) 581-6021
- **Practice address fax:** (240) 581-2020
- **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 |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | NULL | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

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