Provider Demographics
NPI:1760619936
Name:SHAPIRO, SAMUEL MARK (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MARK
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 S LAKE AVE
Mailing Address - Street 2:SUITE 535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-796-8247
Practice Address - Street 1:225 S LAKE AVE
Practice Address - Street 2:SUITE 535
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3005
Practice Address - Country:US
Practice Address - Phone:626-795-6596
Practice Address - Fax:626-796-8247
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2023-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG43276207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92397Medicare UPIN