Provider Demographics
NPI:1932100641
Name:SHORE, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:SHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 KINGS HWY N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2304
Mailing Address - Country:US
Mailing Address - Phone:856-428-8190
Mailing Address - Fax:856-428-8182
Practice Address - Street 1:1500 KINGS HWY N
Practice Address - Street 2:SUITE 106
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2304
Practice Address - Country:US
Practice Address - Phone:856-428-8190
Practice Address - Fax:856-428-8182
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA544872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ577371Medicare ID - Type Unspecified
NJE39069Medicare UPIN