Provider Demographics
NPI:1144258757
Name:SHORE, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 RANDOLPH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2257
Mailing Address - Country:US
Mailing Address - Phone:410-872-9188
Mailing Address - Fax:
Practice Address - Street 1:4701 RANDOLPH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2257
Practice Address - Country:US
Practice Address - Phone:410-872-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20596207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6792001OtherCAREFIRST BCBSDC
MD52494004OtherCAREFIRST BCBS MD
MD52494004OtherCAREFIRST BCBS MD
MDC62047Medicare UPIN
DCG02035R01Medicare ID - Type UnspecifiedDC MEDICARE
DC6792001OtherCAREFIRST BCBSDC