Provider Demographics
NPI:1760589147
Name:SHIH, SHIAO-ANG (MD)
Entity Type:Individual
Prefix:
First Name:SHIAO-ANG
Middle Name:
Last Name:SHIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BROWN ST.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830
Mailing Address - Country:US
Mailing Address - Phone:978-521-6555
Mailing Address - Fax:978-521-1236
Practice Address - Street 1:62 BROWN ST STE 501
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6790
Practice Address - Country:US
Practice Address - Phone:978-521-6555
Practice Address - Fax:978-521-1236
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195949207R00000X
MA240149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083156AMedicaid
MA110159301AMedicaid