Provider Demographics
NPI:1982644175
Name:SHAW, ANDREW BLAIR (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:BLAIR
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERIVCES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8802
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1130 N J ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1913
Practice Address - Country:US
Practice Address - Phone:765-983-3298
Practice Address - Fax:765-983-7970
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99010292084P0800X
IN01083410A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982644175OtherUNITED HEATLCARE
NC1982644175OtherAETNA
NC188031OtherMEDCOST
NC1982644175OtherCIGNA
NC1982644175OtherTRICARE
NC891218FMedicaid
NC1218FOtherBCBS PROVIDER ID #
NC1218FOtherBCBS PROVIDER ID #
NC1982644175OtherTRICARE