Provider Demographics
NPI:1700868965
Name:SHANK, ROWLAND WARD JR (PHD)
Entity Type:Individual
Prefix:
First Name:ROWLAND
Middle Name:WARD
Last Name:SHANK
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 NEFF AVE
Mailing Address - Street 2:UNIT L
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3438
Mailing Address - Country:US
Mailing Address - Phone:540-433-2858
Mailing Address - Fax:540-433-1175
Practice Address - Street 1:370 NEFF AVE
Practice Address - Street 2:UNIT L
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3438
Practice Address - Country:US
Practice Address - Phone:540-433-2858
Practice Address - Fax:540-433-1175
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004404103TC0700X
PAPS004856L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R06367Medicare UPIN
R06367Medicare UPIN
PA155326OtherBLUE SHIELD