Provider Demographics
NPI:1841235009
Name:SHAW, LEON R (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:R
Last Name:SHAW
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 1:1150 VARNUM ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2104
Mailing Address - Country:US
Mailing Address - Phone:202-448-4041
Mailing Address - Fax:202-269-7825
Practice Address - Street 1:1150 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2104
Practice Address - Country:US
Practice Address - Phone:202-448-4041
Practice Address - Fax:202-269-7825
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234439207L00000X
DCMD040830207L00000X
MDD0065441207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289021OtherANTHEM BCBS
VAP00019895OtherMEDICARE - RR
VA1809123-000OtherMEDICAID - WV
VA005720800Medicaid
VA001567S10Medicare ID - Type Unspecified
VA005720800Medicaid