Provider Demographics
NPI:1992709844
Name:BELL, SHAWN LEROY (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:LEROY
Last Name:BELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-533-1555
Mailing Address - Fax:814-535-8720
Practice Address - Street 1:202 BEACHLEY ST
Practice Address - Street 2:
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552-1220
Practice Address - Country:US
Practice Address - Phone:814-634-5935
Practice Address - Fax:814-634-9140
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80953Medicare UPIN
PA068560Medicare ID - Type Unspecified