Provider Demographics
NPI:1568653475
Name:STORM, SHAWN W (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:W
Last Name:STORM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:814-868-2507
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:415 MORRIS STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-388-1700
Practice Address - Fax:304-388-7755
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2351207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010046003OtherAMERICHOICE
NJP3855869OtherOXFORD
NJ0151505Medicaid
NJ3431684000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3K7723OtherHEALTHNET
NJ1737775OtherAETNA
NJ2810734OtherUNITED HEALTHCARE
NJ5557737OtherCIGNA
NJ60033605OtherHORIZON NJ HEALTH
P00645904Medicare PIN
NJ2810734OtherUNITED HEALTHCARE
NJ5557737OtherCIGNA