Provider Demographics
NPI:1134344336
Name:SHAW, JAY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:THOMAS
Last Name:SHAW
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 1:140 CRESTVUE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1815
Mailing Address - Country:US
Mailing Address - Phone:412-341-7825
Mailing Address - Fax:
Practice Address - Street 1:140 CRESTVUE MANOR DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1815
Practice Address - Country:US
Practice Address - Phone:412-341-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037183Y207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28586Medicare UPIN