Individual
DR. SHAJU SHAMSUDDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
667 EASTLAND AVE SE, WARREN, OH 44484-4503
(330) 841-4126
(330) 841-4598
Mailing address
667 EASTLAND AVE SE, WARREN, OH 44484-4503
(330) 841-4126
(330) 841-4598
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
35.069956
OH
2085R0001X
Radiation Oncology Physician
MD062322L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101275823
—
PA
05
—
2075301
—
OH
01
—
H440680
MEDICARE PTAN
OH
Enumeration date
08/17/2005
Last updated
01/01/2017
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