Provider Demographics
NPI:1720134224
Name:SHORE, NEAL ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:ADAM
Last Name:SHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:323 KENT RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2823
Mailing Address - Country:US
Mailing Address - Phone:610-527-4080
Mailing Address - Fax:610-527-4083
Practice Address - Street 1:14 ELLIOTT AVE STE 2
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3412
Practice Address - Country:US
Practice Address - Phone:610-527-4080
Practice Address - Fax:610-527-4083
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021167E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA147863UTRMedicare PIN
PAC31847Medicare UPIN