Provider Demographics
NPI:1073514295
Name:SHAPERO, GRETCHEN H (PA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:H
Last Name:SHAPERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY
Mailing Address - Street 2:STE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2983
Mailing Address - Country:US
Mailing Address - Phone:410-997-0580
Mailing Address - Fax:410-740-8587
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:STE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2983
Practice Address - Country:US
Practice Address - Phone:410-997-0580
Practice Address - Fax:410-740-8587
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC00730363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1251004Medicaid
MD1251004Medicaid