Provider Demographics
NPI:1477783413
Name:SHAW, GERALD L (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7 GREENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1220
Mailing Address - Country:US
Mailing Address - Phone:860-739-0049
Mailing Address - Fax:860-739-9692
Practice Address - Street 1:7 GREENWOOD CIR
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1220
Practice Address - Country:US
Practice Address - Phone:860-739-0049
Practice Address - Fax:860-739-9692
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT014830207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology