Provider Demographics
NPI:1093882425
Name:SHAPIRO, JAY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROBERT
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3913 DUNNEL LANE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3510
Mailing Address - Country:US
Mailing Address - Phone:301-693-1736
Mailing Address - Fax:301-693-1736
Practice Address - Street 1:10215 FERNWOOD RD 102
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1299
Practice Address - Country:US
Practice Address - Phone:301-693-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013812207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD431127YWV2Medicare PIN
MD431111YVZMedicare PIN
MD431111ZDDBMedicare PIN