Provider Demographics
NPI:1205037439
Name:SHEARER, WARREN A (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:A
Last Name:SHEARER
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 1599
Mailing Address - Street 2:PENOBSCOT COMMUNITY HEALTH CENTER
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8100
Mailing Address - Fax:207-992-2065
Practice Address - Street 1:1012 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3060
Practice Address - Country:US
Practice Address - Phone:207-404-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9086Medicare PIN
ME201832Medicare PIN
ME201855Medicare Oscar/Certification
ME001779302Medicare PIN
ME161040203Medicaid
ME161040205Medicaid
ME161040006Medicaid
MEMM9709Medicare Oscar/Certification
ME201845Medicare Oscar/Certification
ME201836Medicare Oscar/Certification
ME161040204Medicaid
ME161040206Medicaid