Individual
SHAMIM DADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
322 E ANTIETAM ST, SUITE 106, HAGERSTOWN, MD 21740-5794
(301) 739-6147
(301) 739-6163
Mailing address
322 E ANTIETAM ST, SUITE 106, HAGERSTOWN, MD 21740-5794
(301) 739-6147
(301) 739-6163
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D68441
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000490229
ANTHEM PROVIDER NUMBER
IN
01
—
11383676
CAQH
IN
05
—
200188770
—
IN
01
—
P00388514
RAILROAD MEDICARE
IN
Enumeration date
01/27/2006
Last updated
02/19/2014
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