Individual
DR. IAN M SHANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 BRANDERMILL BLVD, SUITE 250, GAMBRILLS, MD 21054-1690
(410) 721-1507
(410) 721-1510
Mailing address
PO BOX 12622, BELFAST, ME 04915-4017
(443) 481-6576
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0036203
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002
BCBS
—
01
—
2110345
AETNA HMO
—
01
—
2133458
MAMSI
—
01
—
218331200
AMERIGROUP
—
05
—
278331200
—
MD
01
—
4668884
AETNA PPO
—
01
—
52030309
BCBS
—
01
—
609636400
FEDERAL WORKMANS COMP
—
01
—
9961
KAISER
—
Enumeration date
08/31/2005
Last updated
11/29/2013
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