Provider Demographics
NPI:1114133329
Name:SHAW, GEORGE F
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:F
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2724
Mailing Address - Country:US
Mailing Address - Phone:860-212-2552
Mailing Address - Fax:
Practice Address - Street 1:67 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2724
Practice Address - Country:US
Practice Address - Phone:860-212-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor