Provider Demographics
NPI:1275576480
Name:SHAPIRO, ERIC BRUCE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRUCE
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:300 EVERGREEN DR STE 160
Practice Address - Street 2:NEMOURS DUPONT PEDIATRICS, CONCORDVILLE
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1059
Practice Address - Country:US
Practice Address - Phone:610-358-2410
Practice Address - Fax:610-459-9183
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004112L208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000594757-0001Medicaid