Provider Demographics
NPI:1831163252
Name:SHIN, DAVID H (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 UNION AVE STE C
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2144
Mailing Address - Country:US
Mailing Address - Phone:724-224-6700
Mailing Address - Fax:724-224-8005
Practice Address - Street 1:1621 UNION AVE STE C
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2144
Practice Address - Country:US
Practice Address - Phone:724-224-6700
Practice Address - Fax:724-224-8005
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062342L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001719936Medicaid
PAG55820Medicare UPIN
PA959032Medicare PIN