Provider Demographics
NPI:1477711109
Name:SHAW, EVA NICOLENE PROESCHOLDT (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:NICOLENE PROESCHOLDT
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3150 N ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3881
Mailing Address - Country:US
Mailing Address - Phone:363-716-7811
Mailing Address - Fax:336-713-2020
Practice Address - Street 1:3150 N ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3881
Practice Address - Country:US
Practice Address - Phone:363-716-7811
Practice Address - Fax:336-713-2020
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2010-02080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2010-02080OtherNORTH CAROLINA MEDICAL BOARD