Provider Demographics
NPI:1275597411
Name:ZHU, SHAOBO (MD)
Entity Type:Individual
Prefix:
First Name:SHAOBO
Middle Name:
Last Name:ZHU
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:LABORATORY MEDICINE M C 01 31
Mailing Address - Street 2:100 N. ACADEMY AVE
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-0001
Mailing Address - Country:US
Mailing Address - Phone:570-214-8063
Mailing Address - Fax:570-271-6105
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-0001
Practice Address - Country:US
Practice Address - Phone:570-271-6338
Practice Address - Fax:570-271-6105
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423031207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012695770001Medicaid
091308Medicare ID - Type Unspecified
PA1012695770001Medicaid