Provider Demographics
NPI:1972592814
Name:SHAHEEN, JAMES C (M D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-7850
Practice Address - Fax:570-808-7855
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD064263L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0692016000OtherINDEP. BLUE CROSS
PA1074864OtherKEYSTONE MERCY
PA0016884000001Medicaid
PA1074864OtherAMERIHEALTH MERCY
PA0975824OtherKHP CENTRAL
PA000000095705OtherTHREE RIVERS
PA01688400OtherGATEWAY
PA975824OtherHIGHMARK
PA975824OtherHIGHMARK
PAG66617Medicare UPIN
PA0016884000001Medicaid