Provider Demographics
NPI:1437137866
Name:SHEN, JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:SHEN
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 1:1000 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3420
Mailing Address - Country:US
Mailing Address - Phone:704-982-8112
Mailing Address - Fax:704-982-8097
Practice Address - Street 1:1000 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3420
Practice Address - Country:US
Practice Address - Phone:704-982-8112
Practice Address - Fax:704-982-8097
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36429207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76641OtherBCBS
NC8976641Medicaid
NC8901032Medicaid
F45944Medicare UPIN
NC76641OtherBCBS