Provider Demographics
NPI:1679551816
Name:SHANES, B ADAM (MD)
Entity type:Individual
Prefix:
First Name:B
Middle Name:ADAM
Last Name:SHANES
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:PO BOX 37086
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3086
Mailing Address - Country:US
Mailing Address - Phone:240-439-8812
Mailing Address - Fax:
Practice Address - Street 1:3430 WORTHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7017
Practice Address - Country:US
Practice Address - Phone:240-874-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2093207Q00000X
MDD88618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175702302Medicaid
TXP00466540OtherRR MEDICARE
TX1757023-01Medicaid
TX8J9233Medicare PIN
TXP00466540OtherRR MEDICARE
TX1757023-01Medicaid
TX175702302Medicaid