Provider Demographics
NPI:1275735920
Name:SHAPIRO, JED SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:SCOTT
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:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-0873
Mailing Address - Country:US
Mailing Address - Phone:215-792-2250
Mailing Address - Fax:800-595-4221
Practice Address - Street 1:2201 RIDGEWOOD RD
Practice Address - Street 2:SUITE 160
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1189
Practice Address - Country:US
Practice Address - Phone:215-792-2250
Practice Address - Fax:800-595-4221
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98500207L00000X
VA0101241138207L00000X
PAMD451607207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275735920Medicaid
VA24217YRNMedicare PIN