Provider Demographics
NPI:1376637306
Name:CARROLL ARTHRITIS, PA
Entity Type:Organization
Organization Name:CARROLL ARTHRITIS, PA
Other - Org Name:ROBERT A SHAW, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-848-0364
Mailing Address - Street 1:412 MALCOLM DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6115
Mailing Address - Country:US
Mailing Address - Phone:410-848-0364
Mailing Address - Fax:410-848-4037
Practice Address - Street 1:412 MALCOLM DR
Practice Address - Street 2:SUITE 206
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6115
Practice Address - Country:US
Practice Address - Phone:410-848-0364
Practice Address - Fax:410-848-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD882LMedicare ID - Type Unspecified