Provider Demographics
NPI:1396764403
Name:SHAPIRO, STANLEY M (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
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 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-7111
Mailing Address - Fax:
Practice Address - Street 1:12 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-747-3600
Practice Address - Fax:802-773-8501
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0006968174400000X
VT042-0006968207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT060025588OtherRR MEDICARE
VT0002525Medicaid
VT0002525Medicaid
VTBX4857Medicare PIN