Provider Demographics
NPI:1265834196
Name:SHAMBAUGH PEDIATRICS INC
Entity Type:Organization
Organization Name:SHAMBAUGH PEDIATRICS INC
Other - Org Name:PERRY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-582-2181
Mailing Address - Street 1:106 CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-9675
Mailing Address - Country:US
Mailing Address - Phone:717-582-2181
Mailing Address - Fax:
Practice Address - Street 1:106 CENTRE DR
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-9675
Practice Address - Country:US
Practice Address - Phone:717-582-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty