Provider Demographics
NPI:1992703045
Name:SHAPIRO, NATHAN R (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8525 ROLLING RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3647
Mailing Address - Country:US
Mailing Address - Phone:703-334-0720
Mailing Address - Fax:703-334-0750
Practice Address - Street 1:8525 ROLLING RD
Practice Address - Street 2:SUITE 222
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3647
Practice Address - Country:US
Practice Address - Phone:703-334-0720
Practice Address - Fax:703-334-0750
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148475207R00000X
VA0101244821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112492182OtherPROVIDER ID#
NYKP545OtherOXFORD
NY0084086OtherGHI
NY0084086OtherGHI
NYNSO2224110Medicare ID - Type Unspecified