Provider Demographics
NPI:1861454472
Name:SHAPIRO, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:SHAPIRO
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 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-876-8410
Mailing Address - Fax:703-876-8417
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5218
Practice Address - Country:US
Practice Address - Phone:703-876-8410
Practice Address - Fax:703-876-8417
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010141522080P0202X
MDD158352080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006754716Medicaid
MD304751200Medicaid
068246C58Medicare ID - Type Unspecified
VA006754716Medicaid