Provider Demographics
NPI:1134184070
Name:SHAPIRO, MARC D (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:SHAPIRO
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 1:2111 GLENWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3328
Mailing Address - Country:US
Mailing Address - Phone:407-478-1550
Mailing Address - Fax:407-478-1540
Practice Address - Street 1:2111 GLENWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3328
Practice Address - Country:US
Practice Address - Phone:407-478-1550
Practice Address - Fax:407-478-1540
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049371600Medicaid
FL049371600Medicaid
FLD61528Medicare UPIN