Provider Demographics
NPI:1023016086
Name:SHAW, HOWARD ANDREW (MD, MBA)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:ANDREW
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2110
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-7945
Practice Address - Fax:860-714-8880
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT042731Medicaid
CTE68796Medicare UPIN
CT160002204Medicare ID - Type Unspecified