Provider Demographics
NPI:1861494437
Name:SHAPIRO, MARK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
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 1:1311 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6305
Mailing Address - Country:US
Mailing Address - Phone:336-378-9993
Mailing Address - Fax:336-274-5884
Practice Address - Street 1:1311 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6305
Practice Address - Country:US
Practice Address - Phone:336-378-9993
Practice Address - Fax:336-274-5884
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20509207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC180025125OtherRAILROAD MEDICARE
NC890249UMedicaid
NCAS7656068OtherDR.MTS,MD
NCC86408Medicare UPIN
NC890249UMedicaid
NC180025125OtherRAILROAD MEDICARE
NC210337DMedicare PIN