Provider Demographics
NPI:1134116247
Name:SHOR, STANFORD ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:ALAN
Last Name:SHOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:61 S MORTON AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1740
Mailing Address - Country:US
Mailing Address - Phone:610-328-4460
Mailing Address - Fax:610-328-6178
Practice Address - Street 1:61 S MORTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1740
Practice Address - Country:US
Practice Address - Phone:610-328-4460
Practice Address - Fax:610-328-6178
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS002218L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD66300Medicare UPIN
PA41596Medicare PIN