Provider Demographics
NPI:1265412423
Name:NEAL ADAM SHORE MD LLC
Entity type:Organization
Organization Name:NEAL ADAM SHORE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-527-4080
Mailing Address - Street 1:1062 E LANCASTER AVE
Mailing Address - Street 2:STE 9
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1552
Mailing Address - Country:US
Mailing Address - Phone:610-527-4080
Mailing Address - Fax:610-527-4083
Practice Address - Street 1:1062 E LANCASTER AVE
Practice Address - Street 2:STE 9
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1552
Practice Address - Country:US
Practice Address - Phone:610-527-4080
Practice Address - Fax:610-527-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-21
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021167E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA147863OtherPA BS HIGHMARK PROVIDER #
PANE096419Medicare ID - Type UnspecifiedGROUP PROVIDER ID#
PAC31847Medicare UPIN
PA147863OtherPA BS HIGHMARK PROVIDER #