Provider Demographics
NPI:1851453765
Name:SHAWE, TOBY (MD)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:
Last Name:SHAWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E WILLOW GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7910
Mailing Address - Country:US
Mailing Address - Phone:215-836-7212
Mailing Address - Fax:215-836-7715
Practice Address - Street 1:910 E WILLOW GROVE AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7910
Practice Address - Country:US
Practice Address - Phone:215-836-7212
Practice Address - Fax:215-836-7715
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044018L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF08912Medicare UPIN