Provider Demographics
NPI:1821599952
Name:THORP, SHANE ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ROBERT
Last Name:THORP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 IVY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1627
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2071
Practice Address - Street 1:600 FITCH ST STE 203
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1634
Practice Address - Country:US
Practice Address - Phone:607-734-2695
Practice Address - Fax:607-734-2917
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY312491208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery