Provider Demographics
NPI:1740450188
Name:ALLA SHPANER MD,PC
Entity type:Organization
Organization Name:ALLA SHPANER MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHPANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-676-4948
Mailing Address - Street 1:2375 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5120
Mailing Address - Country:US
Mailing Address - Phone:215-676-4948
Mailing Address - Fax:215-676-8858
Practice Address - Street 1:2375 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5120
Practice Address - Country:US
Practice Address - Phone:215-676-4948
Practice Address - Fax:215-676-8858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLA SHPANER MD,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067856L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001740475002Medicaid
PA023087Medicare PIN
PAG90219Medicare UPIN