Basic Information
| Provider Information | |||||||||
| NPI: | 1821063108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QURESHI | ||||||||
| FirstName: | SHAKAIB | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30170 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198057170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028305297 | ||||||||
| FaxNumber: | 3026234395 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 LANCASTER PIKE | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198051436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028305297 | ||||||||
| FaxNumber: | 3026565270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 07/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | C10007826 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1215975149 | 05 | DE | MEDICAID | P00308224 | 01 | PA | RAILROAD MEDICARE | OTHER |