Provider Demographics
NPI:1043239544
Name:SHAW, ALLEN D (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:D
Last Name:SHAW
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 1:60 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1186
Mailing Address - Country:US
Mailing Address - Phone:740-779-4100
Mailing Address - Fax:740-779-4149
Practice Address - Street 1:60 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1186
Practice Address - Country:US
Practice Address - Phone:740-779-4100
Practice Address - Fax:740-779-4149
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.059008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0813785Medicaid
OHSH7224331Medicare ID - Type Unspecified
OH0813785Medicaid