Individual
B ADAM SHANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3430 WORTHINGTON BLVD, FREDERICK, MD 21704-7017
(240) 874-2530
Mailing address
PO BOX 37086, BALTIMORE, MD 21297-3086
(240) 439-8812
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D88618
MD
207Q00000X
Family Medicine Physician
M2093
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1757023-01
—
TX
05
—
175702302
—
TX
01
—
P00466540
RR MEDICARE
TX
Enumeration date
01/06/2006
Last updated
08/20/2020
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