Organization
MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
Active
Other names
MedStar Shah Medical Group, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC R WAGNER (EXECUTIVE VICE PRESIDENT)
(410) 772-6595
Entity
Organization
Contact information
Practice address
24035 THREE NOTCH ROAD, HOLLYWOOD, MD 20636-4871
(301) 373-7900
(301) 373-6900
Mailing address
24035 THREE NOTCH RD, HOLLYWOOD, MD 20636-4871
(301) 373-7900
(301) 373-6900
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
09/30/2014
Last updated
03/12/2026
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