Provider Demographics
NPI:1538232723
Name:SHEN, BRIAN C (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:501 N FREDERICK AVE
Practice Address - Street 2:KAISER PERMANENTE GAITHERSBURG MEDICAL CENTER
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2598
Practice Address - Country:US
Practice Address - Phone:301-258-7245
Practice Address - Fax:301-258-7294
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD22160207R00000X
VA0101059128207R00000X
MDD0050209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82432Medicare UPIN
002157M92Medicare ID - Type Unspecified