Provider Demographics
NPI:1780685792
Name:PARMER, SHANE SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:SCOTT
Last Name:PARMER
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:807 FARSON ST STE 230
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-423-3223
Practice Address - Fax:740-401-0437
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073786L208600000X
SC874982086S0129X
WV225082086S0129X
OH35.0885492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000696943OtherANTHEM
OHP00799798OtherRRMCR
OH2708387Medicaid
OH000000640672OtherANTHEM
WV3810006650Medicaid
WV3810006650Medicaid
OH4194235Medicare PIN
OHP00799798OtherRRMCR