Provider Demographics
NPI:1952333494
Name:SHIN, NARA C (MD)
Entity Type:Individual
Prefix:
First Name:NARA
Middle Name:C
Last Name:SHIN
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:WASHINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08544-0001
Mailing Address - Country:US
Mailing Address - Phone:609-258-3141
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-5002
Practice Address - Country:US
Practice Address - Phone:609-258-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432435207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101980886Medicaid
NJ0140376Medicaid
PA116392Medicare PIN