Provider Demographics
NPI:1699706184
Name:SHORE, STEVEN LEWIS (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEWIS
Last Name:SHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:993 F JOHNSON FERRY RD
Mailing Address - Street 2:STE 370
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-4611
Mailing Address - Fax:404-256-1759
Practice Address - Street 1:993 F JOHNSON FERRY RD
Practice Address - Street 2:STE 370
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-4611
Practice Address - Fax:404-256-1759
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA015611208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63636Medicare UPIN
GA37BBDZKMedicare ID - Type Unspecified