Provider Demographics
NPI:1093789232
Name:SHAW, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7400
Mailing Address - Country:US
Mailing Address - Phone:434-978-2126
Mailing Address - Fax:434-973-4452
Practice Address - Street 1:416 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7400
Practice Address - Country:US
Practice Address - Phone:434-978-2126
Practice Address - Fax:434-973-4452
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080141642OtherMEDICARE PIN
VA142736OtherSOUTHERN HEALTH
VA005638631Medicaid
VA700010936OtherCIGNA
VA45186OtherCOMMUNITY HEALTH
VA45186OtherOPTIMA/SENTARA
VA234066OtherANTHEM SVC/HEALTHKEEPERS
VA267131OtherMAMSI
VA267131OtherMAMSI
VA45186OtherCOMMUNITY HEALTH
E50692Medicare UPIN