Provider Demographics
NPI:1447227764
Name:SHAVES, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:SHAVES
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-883-3483
Mailing Address - Fax:757-627-0334
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-883-3483
Practice Address - Fax:757-627-0334
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010472362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA13834OtherSENTARA
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
VA005818206Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
NC0517LOtherBC/BS
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEATLH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherMULTIPLAN
VAPAROtherTRICARE
VA2125434OtherUHC/MAMSI
VA394416OtherANTHEM
NC890517LMedicaid
VAPAROtherCIGNA
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
NC890517LMedicaid