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Individual

JESSICA SHACKMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
5755 CEDAR LN, COLUMBIA, MD 21044-2912
(410) 740-7890
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D0081355
MD
207P00000X
Emergency Medicine Physician
D81355
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
D81355
MD LICENSE
MD
Enumeration date
04/23/2013
Last updated
03/03/2022
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