Basic Information
| Provider Information | |||||||||
| NPI: | 1750611919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHADDAD | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | ASSAAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICARE ENROLLEMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6501 LOISDALE CT | ||||||||
| Address2: | KAISER PERMANENTE SPRINGFIELD MEDICAL CENTER | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221501826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039221000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2010 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D71805 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD040063 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101248874 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.