1295735603 NPI number — DR. HARRY ROBERT SHAW D.M.D.

Table of content: DR. HARRY ROBERT SHAW D.M.D. (NPI 1295735603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295735603 NPI number — DR. HARRY ROBERT SHAW D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
HARRY
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295735603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7147 SECURITY BLVD
Provider Second Line Business Mailing Address:
SUITE 100 BOULEVARD PLACE
Provider Business Mailing Address City Name:
WINDSOR MILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21244-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-298-8787
Provider Business Mailing Address Fax Number:
410-298-0146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7147 SECURITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 100 BOULEVARD PLACE
Provider Business Practice Location Address City Name:
WINDSOR MILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21244-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-298-8787
Provider Business Practice Location Address Fax Number:
410-298-0146
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5615 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124148 . This is a "EHP, JH HEALTHCARE LLC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 173281 . This is a "UNITED CONCORDIA HONORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5775 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 95695 . This is a "DENTAL BENEFIT PROVIDERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 838342 . This is a "TRICARE ACTIVE DUTY" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD0101612 . This is a "MONTGOMERY WARD ENTERPRIS" identifier . This identifiers is of the category "OTHER".




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