Provider Demographics
NPI:1740310390
Name:SHANK, LAURA DAWN (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DAWN
Last Name:SHANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-3884
Mailing Address - Fax:717-851-3382
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-3884
Practice Address - Fax:717-851-3382
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120281OtherGEISINGER HEALTH PLAN
PA102194292Medicaid
PA20078635OtherAMERIHEALTH MERCY-WMG
PA249998OtherUNISON-WMG
PA50079530OtherCAPITAL BLUE CROSS-WMG
MD935558OtherCAREFIRST MD BCBS
PA9775205OtherAETNA
PA211820OtherJOHNS HOPKINS
PA102194292Medicaid