Provider Demographics
NPI:1649459322
Name:RONALD SHORE MD PA
Entity type:Organization
Organization Name:RONALD SHORE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-872-9188
Mailing Address - Street 1:4701 RANDOLPH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2261
Mailing Address - Country:US
Mailing Address - Phone:410-872-9188
Mailing Address - Fax:410-872-9169
Practice Address - Street 1:4701 RANDOLPH RD STE 207
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2261
Practice Address - Country:US
Practice Address - Phone:410-872-9188
Practice Address - Fax:410-872-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6792OtherBCBS
MD8216RNOtherBCBS
MD070015957OtherMEDICARE RAIL ROAD
MD8216RNOtherBCBS
MDG02035Medicare PIN