Provider Demographics
NPI:1134355050
Name:SHELL, DONALD (MD, MA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:SHELL
Suffix:
Gender:M
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MCCORMICK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5329
Mailing Address - Country:US
Mailing Address - Phone:301-883-7834
Mailing Address - Fax:301-883-7896
Practice Address - Street 1:1701 MCCORMICK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5329
Practice Address - Country:US
Practice Address - Phone:301-883-7834
Practice Address - Fax:301-883-7896
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40343207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine