Provider Demographics
NPI:1336161546
Name:SHANK, PAUL W (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:SHANK
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 SOUTH PLEASANT AVENUE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501
Mailing Address - Country:US
Mailing Address - Phone:814-443-4634
Mailing Address - Fax:814-445-3819
Practice Address - Street 1:223 SOUTH PLEASANT AVENUE
Practice Address - Street 2:SUITE 405
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-443-4634
Practice Address - Fax:814-445-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043731L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1136002OtherCIGNA
PA340008349OtherRR MEDICARE
PA1500600OtherGATEWAY
PA2053147OtherAETNA
PA202749OtherUPMC
PA953758222OtherPREFERRED HEALTH
PA1472669OtherUMWA
PA273847OtherHEALTH ASSURANCE
PA751881OtherHIGHMARK BC/BS
PA108646OtherBLACK LUNG
PA1458820Medicaid
PA24881OtherHEALTH AMERICA
PA272084OtherMAMSI
PA85515OtherUNISON
PA202749OtherUPMC
PA272084OtherMAMSI