Provider Demographics
NPI:1366464489
Name:SHOMO, MARCIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:R
Last Name:SHOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCIA
Other - Middle Name:R
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 OREGON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4890
Mailing Address - Country:US
Mailing Address - Phone:717-293-3223
Mailing Address - Fax:717-390-2455
Practice Address - Street 1:99 HIGHWAY 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6423
Practice Address - Country:US
Practice Address - Phone:609-597-6011
Practice Address - Fax:609-978-8944
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050796002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44022Medicare UPIN
119915AFUMedicare PIN
NJP00313691Medicare PIN