Provider Demographics
NPI:1558338913
Name:SHAPIRO, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SHAPIRO
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 1:155 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2527
Mailing Address - Country:US
Mailing Address - Phone:203-744-1639
Mailing Address - Fax:203-748-1202
Practice Address - Street 1:155 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2527
Practice Address - Country:US
Practice Address - Phone:203-744-1639
Practice Address - Fax:203-748-1202
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT567690OtherAETNA
CT041902OtherHEALTHNET
CTP413636OtherOXFORD
CT001171776Medicaid
CT010017177CT01OtherBLUE CROSS
CT751459OtherCONNECTICARE
CT001171776Medicaid
CT041902OtherHEALTHNET