Provider Demographics
NPI:1508830902
Name:SHAKER, GEORGE JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JAMES
Last Name:SHAKER
Suffix:JR
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 1:250 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-668-2020
Mailing Address - Fax:603-668-0881
Practice Address - Street 1:250 RIVER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-668-2020
Practice Address - Fax:603-668-0881
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8902207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
136660OtherCIGNA
NH30010796Medicaid
NH0109167Y0NH01OtherANTHEM
F53098OtherHARVARD
NH0109167Y0NH01OtherANTHEM
NHRE2606Medicare ID - Type Unspecified