Provider Demographics
NPI:1629174404
Name:SHAPIRO, RAYMOND (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4025
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20885-4025
Mailing Address - Country:US
Mailing Address - Phone:301-639-8393
Mailing Address - Fax:
Practice Address - Street 1:142 N QUEEN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3312
Practice Address - Country:US
Practice Address - Phone:301-639-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV180452084A0401X, 2084P0800X, 2084P0802X
PAMD042741L2084A0401X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD042741LOtherMEDICAL LICENSE
WV18045OtherMEDICAL LICENSE
MDD45791OtherMEDICAL LICENSE
F16921Medicare UPIN