Active NPI
Shahriar Islam, MD
- Psychiatry Physician
- Philadelphia, PA
National Provider Identifier
1255173100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MT232410
- Practice address
- 100 E Lehigh Ave
Philadelphia, PA 19125-1012 - Phone
- (215) 707-3351
- NPI assigned
- Jun 11, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MT232410 | PA | Primary |
Addresses
Primary practice location
100 E Lehigh Ave
Philadelphia, PA 19125-1012
Mailing address
1300 Fairmount Ave Unit 1420
Philadelphia, PA 19123-2492
Phone (347) 832-6778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240625001538 | PA | Order and Referring Only - Psychiatry | 0143763680 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT232410 | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1255173100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 FAIRMOUNT AVE UNIT 1420",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191232492",
"telephone_number": "347-832-6778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E LEHIGH AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191251012",
"telephone_number": "215-707-3351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISLAM",
"first_name": "SHAHRIAR",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-11",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MT232410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.