Provider Demographics
NPI:1972551257
Name:MCGREGOR, ROBERT SHAYNE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SHAYNE
Last Name:MCGREGOR
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 1:268 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6739
Mailing Address - Country:US
Mailing Address - Phone:215-427-8846
Mailing Address - Fax:215-427-4805
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:SUITE 1111
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-8846
Practice Address - Fax:215-427-4308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 027440-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009044930008Medicaid
PA0009044930008Medicaid
PA429060Medicare ID - Type Unspecified