Provider Demographics
NPI:1619918273
Name:SHAW, ELLEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:W
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1095 RYDAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1711
Mailing Address - Country:US
Mailing Address - Phone:267-620-1100
Mailing Address - Fax:215-572-1279
Practice Address - Street 1:1095 RYDAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1711
Practice Address - Country:US
Practice Address - Phone:267-620-1100
Practice Address - Fax:215-572-1279
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023086E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000605561OtherAMERIHEALTH
PA000605561OtherHIGHMARK BLUE SHIELD
PW14617OtherHEALTH PARTNERS
PA231937219OtherDEVON
PA231937219OtherMULTIPLAN
PWP386705OtherOXFORD
PA015281880004Medicaid
PA231937219OtherTRICARE
PA4611750OtherAETNA
PA0428095000OtherKEYSTONE HEALTH PLAN EAST
PA100006779OtherPALMETTO GBA
PW1024676OtherKEYSTONE MERCY
PA231937219OtherFIRST HEALTH
PA000605561OtherPERSONAL CHOICE
PA1105069005OtherCIGNA
PA231937219OtherDEVON