Provider Demographics
NPI:1689608127
Name:SHAW, MARK R (DO)
Entity Type:Individual
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First Name:MARK
Middle Name:R
Last Name:SHAW
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:120 RADNOR RD
Mailing Address - Street 2:STE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7970
Mailing Address - Country:US
Mailing Address - Phone:814-231-7868
Mailing Address - Fax:814-238-4169
Practice Address - Street 1:120 RADNOR RD
Practice Address - Street 2:STE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-231-7868
Practice Address - Fax:814-238-4169
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-06-14
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Provider Licenses
StateLicense IDTaxonomies
PAOS004761L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine