Provider Demographics
NPI:1700672847
Name:SHAH, SYED ADII MIR
Entity type:Individual
Prefix:
First Name:SYED ADII MIR
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 NORTH CHARLES STREET, GREAT BALTIMORE MEDICAL CENT
Mailing Address - Street 2:PPE SUITE 203
Mailing Address - City:BALTIMORE/TOWNSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-2688
Mailing Address - Fax:443-849-8138
Practice Address - Street 1:6701 NORTH CHARLES STREET, GREAT BALTIMORE MEDICAL CENT
Practice Address - Street 2:PPE SUITE 203
Practice Address - City:BALTIMORE/TOWNSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-849-2688
Practice Address - Fax:443-849-8138
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program