Provider Demographics
NPI:1205814258
Name:SHAPIRO, SCOTT B (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:SHAPIRO
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 1:6640 OLD MONROE RD STE G
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5360
Mailing Address - Country:US
Mailing Address - Phone:704-282-9355
Mailing Address - Fax:
Practice Address - Street 1:6640 OLD MONROE RD STE G
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5360
Practice Address - Country:US
Practice Address - Phone:704-282-9355
Practice Address - Fax:888-859-9355
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601722207V00000X
KYR25322083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891004MMedicaid
NCE75968Medicare UPIN
NC891004MMedicaid