Provider Demographics
NPI:1124000799
Name:SHOAF, EDWIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:H
Last Name:SHOAF
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1750
Mailing Address - Fax:704-384-1748
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-384-1750
Practice Address - Fax:704-384-1748
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN02025Medicaid
NC8975968Medicaid
NC210384GMedicare ID - Type Unspecified
NC8975968Medicaid
NCC81105Medicare UPIN