Provider Demographics
NPI:1528387438
Name:SHAW, JUSTIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:SHAW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:485 ROYER DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5102
Mailing Address - Country:US
Mailing Address - Phone:717-560-4020
Mailing Address - Fax:717-560-2919
Practice Address - Street 1:485 ROYER DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5102
Practice Address - Country:US
Practice Address - Phone:717-560-4020
Practice Address - Fax:717-560-2919
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2020-12-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD454562207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030216600001Medicaid
PA1030216600001Medicaid